|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$61.47
|
|
|
Service Code
|
NDC 47781-424-47
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$55.32 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.96
|
| Rate for Payer: Cash Price |
$49.18
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Cofinity Commercial |
$52.86
|
| Rate for Payer: Healthscope Commercial |
$55.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.25
|
| Rate for Payer: PHP Commercial |
$52.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.03
|
| Rate for Payer: Priority Health SBD |
$38.73
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 60505-7006-0
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Aetna Commercial |
$7.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.07
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Commercial |
$8.03
|
| Rate for Payer: Healthscope Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.94
|
| Rate for Payer: PHP Commercial |
$7.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.54
|
| Rate for Payer: Priority Health SBD |
$5.88
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 47781-424-11
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.00
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$11.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.46
|
| Rate for Payer: PHP Commercial |
$10.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.61
|
| Rate for Payer: Priority Health SBD |
$7.75
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$46.69
|
|
|
Service Code
|
NDC 60505-7006-2
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.41 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna Commercial |
$39.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Cofinity Commercial |
$40.15
|
| Rate for Payer: Healthscope Commercial |
$42.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.69
|
| Rate for Payer: PHP Commercial |
$39.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health SBD |
$29.41
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.24
|
|
|
Service Code
|
NDC 60505-7007-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.29 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.86
|
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Cofinity Commercial |
$54.77
|
| Rate for Payer: Cofinity Commercial |
$67.29
|
| Rate for Payer: Healthscope Commercial |
$70.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.50
|
| Rate for Payer: PHP Commercial |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.77
|
| Rate for Payer: Priority Health SBD |
$49.29
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$15.65
|
|
|
Service Code
|
NDC 60505-7007-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna Commercial |
$13.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.17
|
| Rate for Payer: Cash Price |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$13.46
|
| Rate for Payer: Healthscope Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.30
|
| Rate for Payer: PHP Commercial |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.96
|
| Rate for Payer: Priority Health SBD |
$9.86
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
NDC 60505-7082-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.75 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.75
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$105.27
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.83
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.27
|
| Rate for Payer: Priority Health SBD |
$94.75
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$30.08
|
|
|
Service Code
|
NDC 60505-7082-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.55
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cofinity Commercial |
$21.06
|
| Rate for Payer: Cofinity Commercial |
$25.87
|
| Rate for Payer: Healthscope Commercial |
$27.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.57
|
| Rate for Payer: PHP Commercial |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.06
|
| Rate for Payer: Priority Health SBD |
$18.95
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
IP
|
$34.71
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$31.24 |
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: Priority Health SBD |
$21.87
|
|
|
FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$125.16
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
30807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$112.64 |
| Rate for Payer: Aetna Commercial |
$106.39
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$87.61
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.61
|
| Rate for Payer: Priority Health SBD |
$78.85
|
| Rate for Payer: Priority Health SBD |
$51.03
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
IP
|
$101.50
|
|
|
Service Code
|
NDC 70092-1103-36
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.98
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Cofinity Commercial |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Healthscope Commercial |
$91.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.28
|
| Rate for Payer: PHP Commercial |
$86.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.05
|
| Rate for Payer: Priority Health SBD |
$63.94
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
IP
|
$23.80
|
|
|
Service Code
|
NDC 9900-0018-37
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$20.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.47
|
| Rate for Payer: Cash Price |
$19.04
|
| Rate for Payer: Cofinity Commercial |
$16.66
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.23
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.66
|
| Rate for Payer: Priority Health SBD |
$14.99
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.47
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$15.03
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Healthscope Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.25
|
| Rate for Payer: PHP Commercial |
$18.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.03
|
| Rate for Payer: Priority Health SBD |
$13.53
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.69
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$16.82 |
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Commercial |
$29.25
|
| Rate for Payer: Aetna Commercial |
$19.75
|
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$29.41
|
| Rate for Payer: Aetna Commercial |
$43.52
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Aetna Commercial |
$37.82
|
| Rate for Payer: Aetna Commercial |
$8.62
|
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$8.11
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cash Price |
$12.91
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cash Price |
$38.88
|
| Rate for Payer: Cash Price |
$18.59
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$27.53
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$24.22
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$29.76
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$24.30
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$34.02
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.07
|
| Rate for Payer: Cofinity Commercial |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$24.09
|
| Rate for Payer: Cofinity Commercial |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$16.27
|
| Rate for Payer: Cofinity Commercial |
$9.53
|
| Rate for Payer: Cofinity Commercial |
$29.59
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$33.97
|
| Rate for Payer: Cofinity Commercial |
$27.65
|
| Rate for Payer: Healthscope Commercial |
$43.74
|
| Rate for Payer: Healthscope Commercial |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Healthscope Commercial |
$46.08
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$9.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.34
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Commercial |
$19.75
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: PHP Commercial |
$37.82
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$41.31
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$19.31
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$29.25
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$8.62
|
| Rate for Payer: PHP Commercial |
$43.52
|
| Rate for Payer: PHP Commercial |
$29.41
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Commercial |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.87
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Priority Health SBD |
$10.17
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: Priority Health SBD |
$14.64
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$24.88
|
| Rate for Payer: Priority Health SBD |
$30.62
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$32.26
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: Priority Health SBD |
$6.18
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$6.39
|
| Rate for Payer: Priority Health SBD |
$21.80
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: Priority Health SBD |
$21.68
|
| Rate for Payer: Priority Health SBD |
$14.31
|
| Rate for Payer: Priority Health SBD |
$19.93
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,978.84
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$2,680.96 |
| Rate for Payer: Aetna Commercial |
$2,532.01
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.66
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cofinity Commercial |
$2,561.80
|
| Rate for Payer: Cofinity Commercial |
$2,085.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$2,680.96
|
| Rate for Payer: Mclaren Medicaid |
$0.63
|
| Rate for Payer: Mclaren Medicare |
$1.15
|
| Rate for Payer: Meridian Medicaid |
$0.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,532.01
|
| Rate for Payer: PACE Medicare |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$2,532.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.19
|
| Rate for Payer: Priority Health Medicare |
$1.15
|
| Rate for Payer: Priority Health SBD |
$1,876.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.18
|
| Rate for Payer: VA VA |
$1.15
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,978.84
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,876.67 |
| Max. Negotiated Rate |
$2,680.96 |
| Rate for Payer: Aetna Commercial |
$2,532.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.25
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cofinity Commercial |
$2,561.80
|
| Rate for Payer: Cofinity Commercial |
$2,085.19
|
| Rate for Payer: Healthscope Commercial |
$2,680.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,532.01
|
| Rate for Payer: PHP Commercial |
$2,532.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.19
|
| Rate for Payer: Priority Health SBD |
$1,876.67
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$56.57
|
|
|
Service Code
|
NDC 59365-6065-0
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$50.91 |
| Rate for Payer: Aetna Commercial |
$48.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.77
|
| Rate for Payer: Cash Price |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$39.60
|
| Rate for Payer: Cofinity Commercial |
$48.65
|
| Rate for Payer: Healthscope Commercial |
$50.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.08
|
| Rate for Payer: PHP Commercial |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.60
|
| Rate for Payer: Priority Health SBD |
$35.64
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$56.57
|
|
|
Service Code
|
NDC 59365-6065-1
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$50.91 |
| Rate for Payer: Aetna Commercial |
$48.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.77
|
| Rate for Payer: Cash Price |
$45.26
|
| Rate for Payer: Cofinity Commercial |
$39.60
|
| Rate for Payer: Cofinity Commercial |
$48.65
|
| Rate for Payer: Healthscope Commercial |
$50.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.08
|
| Rate for Payer: PHP Commercial |
$48.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.60
|
| Rate for Payer: Priority Health SBD |
$35.64
|
|
|
FERROUS SULFATE 15 MG IRON (75 MG)/ML ORAL DROPS
|
Facility
|
IP
|
$64.63
|
|
|
Service Code
|
NDC 5038362750
|
| Hospital Charge Code |
95693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.72 |
| Max. Negotiated Rate |
$58.17 |
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.01
|
| Rate for Payer: Cash Price |
$51.70
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$55.58
|
| Rate for Payer: Healthscope Commercial |
$58.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.94
|
| Rate for Payer: PHP Commercial |
$54.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.24
|
| Rate for Payer: Priority Health SBD |
$40.72
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.18
|
| Rate for Payer: Priority Health SBD |
$7.36
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$32.90
|
|
|
Service Code
|
NDC 904759182
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$29.61 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.38
|
| Rate for Payer: Cash Price |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Healthscope Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.96
|
| Rate for Payer: PHP Commercial |
$27.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.03
|
| Rate for Payer: Priority Health SBD |
$20.73
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 904759180
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.24 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.05
|
| Rate for Payer: Priority Health SBD |
$133.24
|
|
|
FERUMOXYTOL 510 MG/17 ML (30 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,235.05
|
|
|
Service Code
|
HCPCS Q0138
|
| Hospital Charge Code |
98312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1,111.54 |
| Rate for Payer: Aetna Commercial |
$1,049.79
|
| Rate for Payer: Aetna Commercial |
$2,363.28
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,807.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.45
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS MAPPO |
$0.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.05
|
| Rate for Payer: BCBS Trust/PPO |
$1.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.36
|
| Rate for Payer: Cash Price |
$2,224.26
|
| Rate for Payer: Cash Price |
$2,224.26
|
| Rate for Payer: Cash Price |
$988.04
|
| Rate for Payer: Cash Price |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$1,062.14
|
| Rate for Payer: Cofinity Commercial |
$864.54
|
| Rate for Payer: Cofinity Commercial |
$2,391.08
|
| Rate for Payer: Cofinity Commercial |
$1,946.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.36
|
| Rate for Payer: Healthscope Commercial |
$1,111.54
|
| Rate for Payer: Healthscope Commercial |
$2,502.30
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Mclaren Medicare |
$0.36
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,363.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,049.79
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE Medicare |
$0.34
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.36
|
| Rate for Payer: PHP Commercial |
$1,049.79
|
| Rate for Payer: PHP Commercial |
$2,363.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: PHP Medicare Advantage |
$0.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,946.23
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health Medicare |
$0.36
|
| Rate for Payer: Priority Health SBD |
$778.08
|
| Rate for Payer: Priority Health SBD |
$1,751.61
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: Railroad Medicare Medicare |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.36
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: VA VA |
$0.36
|
| Rate for Payer: VA VA |
$0.36
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$13,466.23
|
|
|
Service Code
|
MS-DRG 864
|
| Min. Negotiated Rate |
$6,507.95 |
| Max. Negotiated Rate |
$13,466.23 |
| Rate for Payer: Aetna Medicare |
$7,124.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,563.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,563.09
|
| Rate for Payer: BCBS MAPPO |
$6,850.47
|
| Rate for Payer: BCBS Trust/PPO |
$12,922.87
|
| Rate for Payer: BCN Medicare Advantage |
$6,850.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,850.47
|
| Rate for Payer: Mclaren Medicare |
$6,850.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,192.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,878.04
|
| Rate for Payer: PACE Medicare |
$6,507.95
|
| Rate for Payer: PACE SWMI |
$6,850.47
|
| Rate for Payer: PHP Medicare Advantage |
$6,850.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,668.11
|
| Rate for Payer: Priority Health Medicare |
$6,850.47
|
| Rate for Payer: Priority Health Narrow Network |
$10,134.49
|
| Rate for Payer: Railroad Medicare Medicare |
$6,850.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,466.23
|
| Rate for Payer: UHC Core |
$8,263.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,850.47
|
| Rate for Payer: UHC Exchange |
$8,850.07
|
| Rate for Payer: UHC Medicare Advantage |
$7,055.98
|
| Rate for Payer: VA VA |
$6,850.47
|
|
