Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.05

Service Code	NDC 67457-433-22
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: Cash Price	$9.64
Rate for Payer: Cofinity Commercial	$10.36
Rate for Payer: Cofinity Commercial	$8.44
Rate for Payer: Healthscope Commercial	$10.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.24
Rate for Payer: PHP Commercial	$10.24
Rate for Payer: Priority Health Cigna Priority Health	$8.44
Rate for Payer: Priority Health SBD	$7.59

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.05

Service Code	NDC 67457-433-22
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: BCBS Complete	$4.82
Rate for Payer: Cash Price	$9.64
Rate for Payer: Cofinity Commercial	$10.36
Rate for Payer: Cofinity Commercial	$8.44
Rate for Payer: Healthscope Commercial	$10.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.24
Rate for Payer: PHP Commercial	$10.24
Rate for Payer: Priority Health Cigna Priority Health	$8.44
Rate for Payer: Priority Health SBD	$7.59

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$16.05

Service Code	NDC 63323-739-12
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$14.44
Rate for Payer: Aetna Commercial	$13.64
Rate for Payer: Aetna New Business (MI Preferred)	$10.43
Rate for Payer: Cash Price	$12.84
Rate for Payer: Cofinity Commercial	$11.24
Rate for Payer: Cofinity Commercial	$13.80
Rate for Payer: Healthscope Commercial	$14.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.64
Rate for Payer: PHP Commercial	$13.64
Rate for Payer: Priority Health Cigna Priority Health	$11.24
Rate for Payer: Priority Health SBD	$10.11

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.05

Service Code	NDC 67457-433-00
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: Cash Price	$9.64
Rate for Payer: Cofinity Commercial	$10.36
Rate for Payer: Cofinity Commercial	$8.44
Rate for Payer: Healthscope Commercial	$10.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.24
Rate for Payer: PHP Commercial	$10.24
Rate for Payer: Priority Health Cigna Priority Health	$8.44
Rate for Payer: Priority Health SBD	$7.59

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.21

Service Code	NDC 0641-6022-25
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$7.69
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna New Business (MI Preferred)	$7.94
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$8.55
Rate for Payer: Healthscope Commercial	$10.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.38
Rate for Payer: PHP Commercial	$10.38
Rate for Payer: Priority Health Cigna Priority Health	$8.55
Rate for Payer: Priority Health SBD	$7.69

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.21

Service Code	NDC 0641-6022-25
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna New Business (MI Preferred)	$7.94
Rate for Payer: BCBS Complete	$4.88
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$8.55
Rate for Payer: Healthscope Commercial	$10.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.38
Rate for Payer: PHP Commercial	$10.38
Rate for Payer: Priority Health Cigna Priority Health	$8.55
Rate for Payer: Priority Health SBD	$7.69

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$16.05

Service Code	NDC 63323-739-12
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$14.44
Rate for Payer: Aetna Commercial	$13.64
Rate for Payer: Aetna New Business (MI Preferred)	$10.43
Rate for Payer: BCBS Complete	$6.42
Rate for Payer: Cash Price	$12.84
Rate for Payer: Cofinity Commercial	$11.24
Rate for Payer: Cofinity Commercial	$13.80
Rate for Payer: Healthscope Commercial	$14.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.64
Rate for Payer: PHP Commercial	$13.64
Rate for Payer: Priority Health Cigna Priority Health	$11.24
Rate for Payer: Priority Health SBD	$10.11

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$15.00

Service Code	NDC 70860-751-41
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$12.75
Rate for Payer: Aetna New Business (MI Preferred)	$9.75
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$12.90
Rate for Payer: Healthscope Commercial	$13.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.75
Rate for Payer: PHP Commercial	$12.75
Rate for Payer: Priority Health Cigna Priority Health	$10.50
Rate for Payer: Priority Health SBD	$9.45

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.21

Service Code	NDC 0641-6022-01
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$10.99
Rate for Payer: Aetna Commercial	$10.38
Rate for Payer: Aetna New Business (MI Preferred)	$7.94
Rate for Payer: BCBS Complete	$4.88
Rate for Payer: Cash Price	$9.77
Rate for Payer: Cofinity Commercial	$10.50
Rate for Payer: Cofinity Commercial	$8.55
Rate for Payer: Healthscope Commercial	$10.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.38
Rate for Payer: PHP Commercial	$10.38
Rate for Payer: Priority Health Cigna Priority Health	$8.55
Rate for Payer: Priority Health SBD	$7.69

FAMOTIDINE (PF) 20 MG/2 ML INTRAVENOUS SOLUTION

Facility

$12.05

Service Code	NDC 67457-433-00
Hospital Charge Code	117801
Hospital Revenue Code	250
Min. Negotiated Rate	$4.82
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$10.24
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: BCBS Complete	$4.82
Rate for Payer: Cash Price	$9.64
Rate for Payer: Cofinity Commercial	$10.36
Rate for Payer: Cofinity Commercial	$8.44
Rate for Payer: Healthscope Commercial	$10.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.24
Rate for Payer: PHP Commercial	$10.24
Rate for Payer: Priority Health Cigna Priority Health	$8.44
Rate for Payer: Priority Health SBD	$7.59

FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION

Facility

$12,131.40

Service Code	HCPCS J9358
Hospital Charge Code	192405
Hospital Revenue Code	636
Min. Negotiated Rate	$7,642.78
Max. Negotiated Rate	$10,918.26
Rate for Payer: Aetna Commercial	$10,311.69
Rate for Payer: Aetna New Business (MI Preferred)	$7,885.41
Rate for Payer: Cash Price	$9,705.12
Rate for Payer: Cofinity Commercial	$10,433.00
Rate for Payer: Cofinity Commercial	$8,491.98
Rate for Payer: Healthscope Commercial	$10,918.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10,311.69
Rate for Payer: PHP Commercial	$10,311.69
Rate for Payer: Priority Health Cigna Priority Health	$8,491.98
Rate for Payer: Priority Health SBD	$7,642.78

FAM-TRASTUZUMAB DERUXTECAN-NXKI 100 MG INTRAVENOUS SOLUTION

Facility

$12,131.40

Service Code	HCPCS J9358
Hospital Charge Code	192405
Hospital Revenue Code	636
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$10,918.26
Rate for Payer: Aetna Commercial	$10,311.69
Rate for Payer: Aetna Medicare	$28.33
Rate for Payer: Aetna New Business (MI Preferred)	$7,885.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$34.05
Rate for Payer: Amish Plain Church Group Commercial	$34.05
Rate for Payer: BCBS Complete	$15.65
Rate for Payer: BCBS MAPPO	$27.24
Rate for Payer: BCBS Trust/PPO	$80.63
Rate for Payer: BCN Medicare Advantage	$27.24
Rate for Payer: Cash Price	$9,705.12
Rate for Payer: Cash Price	$9,705.12
Rate for Payer: Cofinity Commercial	$8,491.98
Rate for Payer: Cofinity Commercial	$10,433.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.24
Rate for Payer: Healthscope Commercial	$10,918.26
Rate for Payer: Mclaren Medicaid	$14.90
Rate for Payer: Mclaren Medicare	$27.24
Rate for Payer: Meridian Medicaid	$15.65
Rate for Payer: Meridian Wellcare - Medicare Advantage	$28.60
Rate for Payer: MI Amish Medical Board Commercial	$31.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10,311.69
Rate for Payer: PACE Medicare	$25.88
Rate for Payer: PACE SWMI	$27.24
Rate for Payer: PHP Commercial	$10,311.69
Rate for Payer: PHP Medicare Advantage	$27.24
Rate for Payer: Priority Health Choice Medicaid	$14.90
Rate for Payer: Priority Health Cigna Priority Health	$8,491.98
Rate for Payer: Priority Health Medicare	$27.24
Rate for Payer: Priority Health SBD	$7,642.78
Rate for Payer: Railroad Medicare Medicare	$27.24
Rate for Payer: UHC Dual Complete DSNP	$27.24
Rate for Payer: UHC Medicare Advantage	$28.06
Rate for Payer: VA VA	$27.24

FASCIA LATA GRAFT; BY INCISION AND AREA EXPOSURE, COMPLEX OR SHEET

Facility

$5,175.07

Service Code	CPT 20922
Hospital Revenue Code	360
Min. Negotiated Rate	$494.76
Max. Negotiated Rate	$5,175.07
Rate for Payer: Aetna Medicare	$1,687.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,028.30
Rate for Payer: Amish Plain Church Group Commercial	$2,028.30
Rate for Payer: BCBS Complete	$932.04
Rate for Payer: BCBS MAPPO	$1,622.64
Rate for Payer: BCBS Trust/PPO	$1,174.90
Rate for Payer: BCN Medicare Advantage	$1,622.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,622.64
Rate for Payer: Mclaren Medicaid	$887.58
Rate for Payer: Mclaren Medicare	$1,622.64
Rate for Payer: Meridian Medicaid	$932.04
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,703.77
Rate for Payer: MI Amish Medical Board Commercial	$1,866.04
Rate for Payer: PACE Medicare	$1,541.51
Rate for Payer: PACE SWMI	$1,622.64
Rate for Payer: PHP Medicare Advantage	$1,622.64
Rate for Payer: Priority Health Choice Medicaid	$887.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,175.07
Rate for Payer: Priority Health Medicare	$1,622.64
Rate for Payer: Priority Health Narrow Network	$4,140.06
Rate for Payer: Railroad Medicare Medicare	$1,622.64
Rate for Payer: UHC All Payor (Choice/PPO)	$544.24
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,622.64
Rate for Payer: UHC Exchange	$494.76
Rate for Payer: UHC Medicare Advantage	$1,671.32
Rate for Payer: VA VA	$1,622.64

FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT);

Facility

$5,427.00

Service Code	CPT 26123
Hospital Revenue Code	360
Min. Negotiated Rate	$836.29
Max. Negotiated Rate	$5,427.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,812.73
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$919.92
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$836.29
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

Facility

$878.00

Service Code	CPT 26125
Hospital Revenue Code	360
Min. Negotiated Rate	$261.95
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$557.71
Rate for Payer: UHC All Payor (Choice/PPO)	$288.14
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$261.95

FAT EMULSION 20 % INTRAVENOUS

Facility

$100.00

Service Code	NDC 0338-0519-09
Hospital Charge Code	10014
Hospital Revenue Code	250
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health SBD	$63.00

FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS

Facility

$13.00

Service Code	NDC 0338-9540-03
Hospital Charge Code	191280
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: Aetna New Business (MI Preferred)	$8.45
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cofinity Commercial	$11.18
Rate for Payer: Cofinity Commercial	$9.10
Rate for Payer: Healthscope Commercial	$11.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.05
Rate for Payer: PHP Commercial	$11.05
Rate for Payer: Priority Health Cigna Priority Health	$9.10
Rate for Payer: Priority Health SBD	$8.19

FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS

Facility

$22.50

Service Code	NDC 63323-820-74
Hospital Charge Code	179808
Hospital Revenue Code	250
Min. Negotiated Rate	$14.18
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$19.12
Rate for Payer: Aetna New Business (MI Preferred)	$14.62
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cofinity Commercial	$15.75
Rate for Payer: Cofinity Commercial	$19.35
Rate for Payer: Healthscope Commercial	$20.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.12
Rate for Payer: PHP Commercial	$19.12
Rate for Payer: Priority Health Cigna Priority Health	$15.75
Rate for Payer: Priority Health SBD	$14.18

FECAL MICROBIOTA PRODUCT

Facility

$2,499.70

Service Code	NDC 9900-0011-29
Hospital Charge Code	300149
Hospital Revenue Code	250
Min. Negotiated Rate	$1,574.81
Max. Negotiated Rate	$2,249.73
Rate for Payer: Aetna Commercial	$2,124.74
Rate for Payer: Aetna New Business (MI Preferred)	$1,624.80
Rate for Payer: Cash Price	$1,999.76
Rate for Payer: Cofinity Commercial	$1,749.79
Rate for Payer: Cofinity Commercial	$2,149.74
Rate for Payer: Healthscope Commercial	$2,249.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,124.74
Rate for Payer: PHP Commercial	$2,124.74
Rate for Payer: Priority Health Cigna Priority Health	$1,749.79
Rate for Payer: Priority Health SBD	$1,574.81

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$32,705.73

Service Code	MS-DRG 748
Min. Negotiated Rate	$10,080.00
Max. Negotiated Rate	$32,705.73
Rate for Payer: Aetna Medicare	$11,034.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,263.16
Rate for Payer: Amish Plain Church Group Commercial	$13,263.16
Rate for Payer: BCBS MAPPO	$10,610.53
Rate for Payer: BCBS Trust/PPO	$32,705.73
Rate for Payer: BCN Medicare Advantage	$10,610.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,610.53
Rate for Payer: Mclaren Medicare	$10,610.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,141.06
Rate for Payer: MI Amish Medical Board Commercial	$12,202.11
Rate for Payer: PACE Medicare	$10,080.00
Rate for Payer: PACE SWMI	$10,610.53
Rate for Payer: PHP Medicare Advantage	$10,610.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,160.20
Rate for Payer: Priority Health Medicare	$10,610.53
Rate for Payer: Priority Health Narrow Network	$16,128.16
Rate for Payer: Railroad Medicare Medicare	$10,610.53
Rate for Payer: UHC All Payor (Choice/PPO)	$21,430.34
Rate for Payer: UHC Core	$13,149.86
Rate for Payer: UHC Dual Complete DSNP	$10,610.53
Rate for Payer: UHC Exchange	$14,084.12
Rate for Payer: UHC Medicare Advantage	$10,928.85
Rate for Payer: VA VA	$10,610.53

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$28.66

Service Code	NDC 60505-7009-0
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$25.79
Rate for Payer: Aetna Commercial	$24.36
Rate for Payer: Aetna New Business (MI Preferred)	$18.63
Rate for Payer: Cash Price	$22.93
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Healthscope Commercial	$25.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.36
Rate for Payer: PHP Commercial	$24.36
Rate for Payer: Priority Health Cigna Priority Health	$20.06
Rate for Payer: Priority Health SBD	$18.06

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$297.70

Service Code	NDC 60505-7084-2
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$187.55
Max. Negotiated Rate	$267.93
Rate for Payer: Aetna Commercial	$253.04
Rate for Payer: Aetna New Business (MI Preferred)	$193.50
Rate for Payer: Cash Price	$238.16
Rate for Payer: Cofinity Commercial	$208.39
Rate for Payer: Cofinity Commercial	$256.02
Rate for Payer: Healthscope Commercial	$267.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$253.04
Rate for Payer: PHP Commercial	$253.04
Rate for Payer: Priority Health Cigna Priority Health	$208.39
Rate for Payer: Priority Health SBD	$187.55

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$143.29

Service Code	NDC 60505-7009-2
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$90.27
Max. Negotiated Rate	$128.96
Rate for Payer: Aetna Commercial	$121.80
Rate for Payer: Aetna New Business (MI Preferred)	$93.14
Rate for Payer: Cash Price	$114.63
Rate for Payer: Cofinity Commercial	$100.30
Rate for Payer: Cofinity Commercial	$123.23
Rate for Payer: Healthscope Commercial	$128.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$121.80
Rate for Payer: PHP Commercial	$121.80
Rate for Payer: Priority Health Cigna Priority Health	$100.30
Rate for Payer: Priority Health SBD	$90.27

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$59.54

Service Code	NDC 60505-7084-0
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$37.51
Max. Negotiated Rate	$53.59
Rate for Payer: Aetna Commercial	$50.61
Rate for Payer: Aetna New Business (MI Preferred)	$38.70
Rate for Payer: Cash Price	$47.63
Rate for Payer: Cofinity Commercial	$41.68
Rate for Payer: Cofinity Commercial	$51.20
Rate for Payer: Healthscope Commercial	$53.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.61
Rate for Payer: PHP Commercial	$50.61
Rate for Payer: Priority Health Cigna Priority Health	$41.68
Rate for Payer: Priority Health SBD	$37.51

FENTANYL 12 MCG/HR TRANSDERMAL PATCH

Facility

$153.22

Service Code	NDC 0378-9119-98
Hospital Charge Code	41382
Hospital Revenue Code	637
Min. Negotiated Rate	$96.53
Max. Negotiated Rate	$137.90
Rate for Payer: Aetna Commercial	$130.24
Rate for Payer: Aetna New Business (MI Preferred)	$99.59
Rate for Payer: Cash Price	$122.58
Rate for Payer: Cofinity Commercial	$107.25
Rate for Payer: Cofinity Commercial	$131.77
Rate for Payer: Healthscope Commercial	$137.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.24
Rate for Payer: PHP Commercial	$130.24
Rate for Payer: Priority Health Cigna Priority Health	$107.25
Rate for Payer: Priority Health SBD	$96.53

Know your out-of-pocket cost for care.

All Charges