|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$109.40
|
|
|
Service Code
|
NDC 47781042447
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.99 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna Medicare |
$54.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.11
|
| Rate for Payer: BCBS Complete |
$43.76
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Advantage |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health SBD |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.11
|
| Rate for Payer: UHC Core |
$57.00
|
| Rate for Payer: UHC Exchange |
$42.99
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$21.88
|
|
|
Service Code
|
NDC 47781042411
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.41
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.22
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Exchange |
$8.60
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$21.88
|
|
|
Service Code
|
NDC 47781042411
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.41
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health SBD |
$13.78
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$134.25
|
|
|
Service Code
|
NDC 50742055205
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.76 |
| Max. Negotiated Rate |
$120.83 |
| Rate for Payer: Aetna Commercial |
$114.11
|
| Rate for Payer: Aetna Medicare |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.26
|
| Rate for Payer: BCBS Complete |
$53.70
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cofinity Advantage |
$93.97
|
| Rate for Payer: Cofinity Commercial |
$115.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.40
|
| Rate for Payer: Healthscope Commercial |
$120.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.69
|
| Rate for Payer: PHP Commercial |
$114.11
|
| Rate for Payer: Priority Health SBD |
$84.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.26
|
| Rate for Payer: UHC Core |
$69.94
|
| Rate for Payer: UHC Exchange |
$52.76
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$134.25
|
|
|
Service Code
|
NDC 50742055205
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.58 |
| Max. Negotiated Rate |
$120.83 |
| Rate for Payer: Aetna Commercial |
$114.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.26
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cofinity Advantage |
$93.97
|
| Rate for Payer: Cofinity Commercial |
$115.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.40
|
| Rate for Payer: Healthscope Commercial |
$120.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.69
|
| Rate for Payer: PHP Commercial |
$114.11
|
| Rate for Payer: Priority Health SBD |
$84.58
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$194.37
|
|
|
Service Code
|
NDC 00406915076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.39 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Aetna Commercial |
$165.21
|
| Rate for Payer: Aetna Medicare |
$97.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.34
|
| Rate for Payer: BCBS Complete |
$77.75
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cofinity Advantage |
$136.06
|
| Rate for Payer: Cofinity Commercial |
$167.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$174.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.78
|
| Rate for Payer: PHP Commercial |
$165.21
|
| Rate for Payer: Priority Health SBD |
$122.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.34
|
| Rate for Payer: UHC Core |
$101.27
|
| Rate for Payer: UHC Exchange |
$76.39
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$194.37
|
|
|
Service Code
|
NDC 00406915076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Aetna Commercial |
$165.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.34
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cofinity Advantage |
$136.06
|
| Rate for Payer: Cofinity Commercial |
$167.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$174.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.78
|
| Rate for Payer: PHP Commercial |
$165.21
|
| Rate for Payer: Priority Health SBD |
$122.45
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$26.85
|
|
|
Service Code
|
NDC 50742055201
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna Medicare |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Advantage |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: Priority Health SBD |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.45
|
| Rate for Payer: UHC Core |
$13.99
|
| Rate for Payer: UHC Exchange |
$10.55
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$26.85
|
|
|
Service Code
|
NDC 50742055201
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Advantage |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: Priority Health SBD |
$16.92
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
IP
|
$20.98
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.22 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$10.07
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$11.06
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
OP
|
$14.39
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Advantage |
$10.07
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
|
|
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 Advantage |
$87.61
|
| Rate for Payer: Cofinity Advantage |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health SBD |
$78.85
|
| Rate for Payer: Priority Health SBD |
$51.03
|
|
|
FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
30807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Commercial |
$106.39
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna Medicare |
$62.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$50.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Advantage |
$87.61
|
| Rate for Payer: Cofinity Advantage |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: Priority Health SBD |
$78.85
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
OP
|
$101.50
|
|
|
Service Code
|
NDC 70092110336
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Aetna Medicare |
$50.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.97
|
| Rate for Payer: BCBS Complete |
$40.60
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Cofinity Advantage |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.20
|
| Rate for Payer: Healthscope Commercial |
$91.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.12
|
| Rate for Payer: PHP Commercial |
$86.28
|
| Rate for Payer: Priority Health SBD |
$63.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.97
|
| Rate for Payer: UHC Core |
$52.88
|
| Rate for Payer: UHC Exchange |
$39.89
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
IP
|
$101.50
|
|
|
Service Code
|
NDC 70092110336
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Aetna Commercial |
$86.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.97
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Cofinity Advantage |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.20
|
| Rate for Payer: Healthscope Commercial |
$91.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.12
|
| Rate for Payer: PHP Commercial |
$86.28
|
| Rate for Payer: Priority Health SBD |
$63.95
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
OP
|
$23.80
|
|
|
Service Code
|
NDC 09900001837
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Aetna Commercial |
$20.23
|
| Rate for Payer: Aetna Medicare |
$11.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.47
|
| Rate for Payer: BCBS Complete |
$9.52
|
| Rate for Payer: Cash Price |
$19.04
|
| Rate for Payer: Cofinity Advantage |
$16.66
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.85
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: Priority Health SBD |
$14.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.47
|
| Rate for Payer: UHC Core |
$12.40
|
| Rate for Payer: UHC Exchange |
$9.35
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
IP
|
$23.80
|
|
|
Service Code
|
NDC 09900001837
|
| 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 Advantage |
$16.66
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.85
|
| Rate for Payer: PHP Commercial |
$20.23
|
| Rate for Payer: Priority Health SBD |
$14.99
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
OP
|
$21.55
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Advantage |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$21.55
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.58 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Advantage |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$19.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health SBD |
$13.58
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$9.85
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$29.41
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.49
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$35.73
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$38.96
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cofinity Advantage |
$6.87
|
| Rate for Payer: Cofinity Advantage |
$34.09
|
| Rate for Payer: Cofinity Advantage |
$24.22
|
| Rate for Payer: Cofinity Advantage |
$17.30
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Advantage |
$27.65
|
| Rate for Payer: Cofinity Advantage |
$9.53
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$10.07
|
| Rate for Payer: Cofinity Advantage |
$14.45
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$6.89
|
| Rate for Payer: Cofinity Advantage |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$41.88
|
| Rate for Payer: Cofinity Commercial |
$29.76
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$33.97
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$43.83
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$29.41
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$37.96
|
| Rate for Payer: PHP Commercial |
$41.40
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$6.18
|
| Rate for Payer: Priority Health SBD |
$28.14
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$21.80
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$13.00
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$30.68
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.98
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$29.41
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Aetna Medicare |
$4.91
|
| Rate for Payer: Aetna Medicare |
$12.36
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$24.35
|
| Rate for Payer: Aetna Medicare |
$19.75
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$22.33
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: BCBS Complete |
$9.89
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Complete |
$5.44
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$3.94
|
| Rate for Payer: BCBS Complete |
$3.92
|
| Rate for Payer: BCBS Complete |
$19.48
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$15.80
|
| Rate for Payer: BCBS Complete |
$8.26
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$38.96
|
| Rate for Payer: Cash Price |
$35.73
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$35.73
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$38.96
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cofinity Advantage |
$34.09
|
| Rate for Payer: Cofinity Advantage |
$12.29
|
| Rate for Payer: Cofinity Advantage |
$10.07
|
| Rate for Payer: Cofinity Advantage |
$10.39
|
| Rate for Payer: Cofinity Advantage |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$9.53
|
| Rate for Payer: Cofinity Advantage |
$31.26
|
| Rate for Payer: Cofinity Advantage |
$6.87
|
| Rate for Payer: Cofinity Advantage |
$24.22
|
| Rate for Payer: Cofinity Advantage |
$14.45
|
| Rate for Payer: Cofinity Advantage |
$17.30
|
| Rate for Payer: Cofinity Advantage |
$6.89
|
| Rate for Payer: Cofinity Advantage |
$27.65
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$29.76
|
| Rate for Payer: Cofinity Commercial |
$33.97
|
| Rate for Payer: Cofinity Commercial |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$41.88
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$43.83
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.13
|
| Rate for Payer: PHP Commercial |
$41.40
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: PHP Commercial |
$29.41
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$37.96
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$13.00
|
| Rate for Payer: Priority Health SBD |
$21.80
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Priority Health SBD |
$28.14
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$30.68
|
| Rate for Payer: Priority Health SBD |
$6.18
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.96
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$3,187.50
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,437.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.38
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cofinity Advantage |
$2,625.00
|
| Rate for Payer: Cofinity Commercial |
$3,225.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3,375.00
|
| Rate for Payer: Mclaren Medicaid |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$1.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.16
|
| Rate for Payer: Meridian Medicaid |
$1.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,187.50
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,812.50
|
| Rate for Payer: PACE Medicare |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3,187.50
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3.49
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health SBD |
$2,362.50
|
| Rate for Payer: Priority Health Tiered Network |
$2.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.85
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.85
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$1.10
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,362.50 |
| Max. Negotiated Rate |
$3,375.00 |
| Rate for Payer: Aetna Commercial |
$3,187.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,437.50
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cofinity Advantage |
$2,625.00
|
| Rate for Payer: Cofinity Commercial |
$3,225.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,000.00
|
| Rate for Payer: Healthscope Commercial |
$3,375.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,187.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,812.50
|
| Rate for Payer: PHP Commercial |
$3,187.50
|
| Rate for Payer: Priority Health SBD |
$2,362.50
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,599.47
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$5,039.52 |
| Rate for Payer: Aetna Commercial |
$4,759.55
|
| Rate for Payer: Aetna Medicare |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,639.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.41
|
| Rate for Payer: BCBS Complete |
$12.04
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$57.25
|
| Rate for Payer: BCN Commercial |
$57.25
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$4,479.58
|
| Rate for Payer: Cash Price |
$4,479.58
|
| Rate for Payer: Cofinity Advantage |
$3,919.63
|
| Rate for Payer: Cofinity Commercial |
$4,815.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,479.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$5,039.52
|
| Rate for Payer: Mclaren Medicaid |
$11.47
|
| Rate for Payer: Mclaren Medicare |
$21.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: Meridian Medicaid |
$23.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,759.55
|
| Rate for Payer: Nomi Health Commercial |
$65.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,199.60
|
| Rate for Payer: PACE Medicare |
$20.83
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$4,759.55
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69.46
|
| Rate for Payer: Priority Health Medicare |
$21.93
|
| Rate for Payer: Priority Health SBD |
$3,527.67
|
| Rate for Payer: Priority Health Tiered Network |
$55.57
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.67
|
| Rate for Payer: UHC Core |
$37.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.93
|
| Rate for Payer: UHC Exchange |
$37.67
|
| Rate for Payer: UHC Medicaid |
$11.47
|
| Rate for Payer: UHCCP Medicaid |
$11.47
|
| Rate for Payer: VA VA |
$21.93
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,599.47
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,527.67 |
| Max. Negotiated Rate |
$5,039.52 |
| Rate for Payer: Aetna Commercial |
$4,759.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,639.66
|
| Rate for Payer: Cash Price |
$4,479.58
|
| Rate for Payer: Cofinity Advantage |
$3,919.63
|
| Rate for Payer: Cofinity Commercial |
$4,815.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,479.58
|
| Rate for Payer: Healthscope Commercial |
$5,039.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,759.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,199.60
|
| Rate for Payer: PHP Commercial |
$4,759.55
|
| Rate for Payer: Priority Health SBD |
$3,527.67
|
|
