Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

$8,907.47

Service Code	CPT 26123
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE)

Facility

$8,907.47

Service Code	CPT 28060
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

FAT EMULSION 20 % INTRAVENOUS

Facility

$100.00

Service Code	NDC 00338051909
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: Cofinity Medicare Advantage	$70.00
Rate for Payer: Encore Health Key Benefits Commercial	$80.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$65.00
Rate for Payer: Priority Health SBD	$63.00

FAT EMULSION 20 % INTRAVENOUS

Facility

$100.00

Service Code	NDC 00338051909
Hospital Charge Code	10014
Hospital Revenue Code	250
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$90.00
Rate for Payer: Aetna Commercial	$85.00
Rate for Payer: Aetna Medicare	$50.00
Rate for Payer: Aetna New Business (MI Preferred)	$65.00
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$70.00
Rate for Payer: Cofinity Commercial	$86.00
Rate for Payer: Cofinity Medicare Advantage	$70.00
Rate for Payer: Encore Health Key Benefits Commercial	$80.00
Rate for Payer: Healthscope Commercial	$90.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$85.00
Rate for Payer: PHP Commercial	$85.00
Rate for Payer: Priority Health Cigna Priority Health	$65.00
Rate for Payer: Priority Health SBD	$63.00

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

Facility

$13.50

Service Code	NDC 00338954003
Hospital Charge Code	191280
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$12.15
Rate for Payer: Aetna Commercial	$11.47
Rate for Payer: Aetna Medicare	$6.75
Rate for Payer: Aetna New Business (MI Preferred)	$8.78
Rate for Payer: BCBS Complete	$5.40
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cofinity Commercial	$11.61
Rate for Payer: Cofinity Commercial	$9.45
Rate for Payer: Cofinity Medicare Advantage	$9.45
Rate for Payer: Encore Health Key Benefits Commercial	$10.80
Rate for Payer: Healthscope Commercial	$12.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.47
Rate for Payer: PHP Commercial	$11.47
Rate for Payer: Priority Health Cigna Priority Health	$8.78
Rate for Payer: Priority Health SBD	$8.51

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

Facility

$13.50

Service Code	NDC 00338954003
Hospital Charge Code	191280
Hospital Revenue Code	250
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$12.15
Rate for Payer: Aetna Commercial	$11.47
Rate for Payer: Aetna New Business (MI Preferred)	$8.78
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cofinity Commercial	$11.61
Rate for Payer: Cofinity Commercial	$9.45
Rate for Payer: Cofinity Medicare Advantage	$9.45
Rate for Payer: Encore Health Key Benefits Commercial	$10.80
Rate for Payer: Healthscope Commercial	$12.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.47
Rate for Payer: PHP Commercial	$11.47
Rate for Payer: Priority Health Cigna Priority Health	$8.78
Rate for Payer: Priority Health SBD	$8.51

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

Facility

$24.00

Service Code	NDC 63323082074
Hospital Charge Code	179808
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: Aetna New Business (MI Preferred)	$15.60
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$16.80
Rate for Payer: Cofinity Commercial	$20.64
Rate for Payer: Cofinity Medicare Advantage	$16.80
Rate for Payer: Encore Health Key Benefits Commercial	$19.20
Rate for Payer: Healthscope Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.40
Rate for Payer: PHP Commercial	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$15.60
Rate for Payer: Priority Health SBD	$15.12

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

Facility

$24.00

Service Code	NDC 63323082074
Hospital Charge Code	179808
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$15.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$16.80
Rate for Payer: Cofinity Commercial	$20.64
Rate for Payer: Cofinity Medicare Advantage	$16.80
Rate for Payer: Encore Health Key Benefits Commercial	$19.20
Rate for Payer: Healthscope Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.40
Rate for Payer: PHP Commercial	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$15.60
Rate for Payer: Priority Health SBD	$15.12

FECAL MICROBIOTA PRODUCT

Facility

$2,499.70

Service Code	NDC 09900001129
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)	$1,624.81
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: Cofinity Medicare Advantage	$1,749.79
Rate for Payer: Encore Health Key Benefits Commercial	$1,999.76
Rate for Payer: Healthscope Commercial	$2,249.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,124.74
Rate for Payer: PHP Commercial	$2,124.74
Rate for Payer: Priority Health Cigna Priority Health	$1,624.81
Rate for Payer: Priority Health SBD	$1,574.81

FECAL MICROBIOTA PRODUCT

Facility

$2,499.70

Service Code	NDC 09900001129
Hospital Charge Code	300149
Hospital Revenue Code	250
Min. Negotiated Rate	$999.88
Max. Negotiated Rate	$2,249.73
Rate for Payer: Aetna Commercial	$2,124.74
Rate for Payer: Aetna Medicare	$1,249.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,624.81
Rate for Payer: BCBS Complete	$999.88
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: Cofinity Medicare Advantage	$1,749.79
Rate for Payer: Encore Health Key Benefits Commercial	$1,999.76
Rate for Payer: Healthscope Commercial	$2,249.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,124.74
Rate for Payer: PHP Commercial	$2,124.74
Rate for Payer: Priority Health Cigna Priority Health	$1,624.81
Rate for Payer: Priority Health SBD	$1,574.81

FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET

Facility

$952.75

Service Code	NDC 51079060820
Hospital Charge Code	40010
Hospital Revenue Code	637
Min. Negotiated Rate	$381.10
Max. Negotiated Rate	$857.48
Rate for Payer: Aetna Commercial	$809.84
Rate for Payer: Aetna Medicare	$476.38
Rate for Payer: Aetna New Business (MI Preferred)	$619.29
Rate for Payer: BCBS Complete	$381.10
Rate for Payer: Cash Price	$762.20
Rate for Payer: Cofinity Commercial	$666.92
Rate for Payer: Cofinity Commercial	$819.37
Rate for Payer: Cofinity Medicare Advantage	$666.92
Rate for Payer: Encore Health Key Benefits Commercial	$762.20
Rate for Payer: Healthscope Commercial	$857.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$809.84
Rate for Payer: PHP Commercial	$809.84
Rate for Payer: Priority Health Cigna Priority Health	$619.29
Rate for Payer: Priority Health SBD	$600.23

FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET

Facility

$952.75

Service Code	NDC 51079060820
Hospital Charge Code	40010
Hospital Revenue Code	637
Min. Negotiated Rate	$600.23
Max. Negotiated Rate	$857.48
Rate for Payer: Aetna Commercial	$809.84
Rate for Payer: Aetna New Business (MI Preferred)	$619.29
Rate for Payer: Cash Price	$762.20
Rate for Payer: Cofinity Commercial	$666.92
Rate for Payer: Cofinity Commercial	$819.37
Rate for Payer: Cofinity Medicare Advantage	$666.92
Rate for Payer: Encore Health Key Benefits Commercial	$762.20
Rate for Payer: Healthscope Commercial	$857.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$809.84
Rate for Payer: PHP Commercial	$809.84
Rate for Payer: Priority Health Cigna Priority Health	$619.29
Rate for Payer: Priority Health SBD	$600.23

FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET

Facility

$121.68

Service Code	NDC 60687061821
Hospital Charge Code	40009
Hospital Revenue Code	637
Min. Negotiated Rate	$76.66
Max. Negotiated Rate	$109.51
Rate for Payer: Aetna Commercial	$103.43
Rate for Payer: Aetna New Business (MI Preferred)	$79.09
Rate for Payer: Cash Price	$97.34
Rate for Payer: Cofinity Commercial	$104.64
Rate for Payer: Cofinity Commercial	$85.18
Rate for Payer: Cofinity Medicare Advantage	$85.18
Rate for Payer: Encore Health Key Benefits Commercial	$97.34
Rate for Payer: Healthscope Commercial	$109.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.43
Rate for Payer: PHP Commercial	$103.43
Rate for Payer: Priority Health Cigna Priority Health	$79.09
Rate for Payer: Priority Health SBD	$76.66

FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET

Facility

$4.06

Service Code	NDC 60687061811
Hospital Charge Code	40009
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$3.45
Rate for Payer: Aetna New Business (MI Preferred)	$2.64
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cofinity Commercial	$2.84
Rate for Payer: Cofinity Commercial	$3.49
Rate for Payer: Cofinity Medicare Advantage	$2.84
Rate for Payer: Encore Health Key Benefits Commercial	$3.25
Rate for Payer: Healthscope Commercial	$3.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.45
Rate for Payer: PHP Commercial	$3.45
Rate for Payer: Priority Health Cigna Priority Health	$2.64
Rate for Payer: Priority Health SBD	$2.56

FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET

Facility

$121.68

Service Code	NDC 60687061821
Hospital Charge Code	40009
Hospital Revenue Code	637
Min. Negotiated Rate	$48.67
Max. Negotiated Rate	$109.51
Rate for Payer: Aetna Commercial	$103.43
Rate for Payer: Aetna Medicare	$60.84
Rate for Payer: Aetna New Business (MI Preferred)	$79.09
Rate for Payer: BCBS Complete	$48.67
Rate for Payer: Cash Price	$97.34
Rate for Payer: Cofinity Commercial	$104.64
Rate for Payer: Cofinity Commercial	$85.18
Rate for Payer: Cofinity Medicare Advantage	$85.18
Rate for Payer: Encore Health Key Benefits Commercial	$97.34
Rate for Payer: Healthscope Commercial	$109.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.43
Rate for Payer: PHP Commercial	$103.43
Rate for Payer: Priority Health Cigna Priority Health	$79.09
Rate for Payer: Priority Health SBD	$76.66

FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET

Facility

$4.06

Service Code	NDC 60687061811
Hospital Charge Code	40009
Hospital Revenue Code	637
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$3.65
Rate for Payer: Aetna Commercial	$3.45
Rate for Payer: Aetna Medicare	$2.03
Rate for Payer: Aetna New Business (MI Preferred)	$2.64
Rate for Payer: BCBS Complete	$1.62
Rate for Payer: Cash Price	$3.25
Rate for Payer: Cofinity Commercial	$2.84
Rate for Payer: Cofinity Commercial	$3.49
Rate for Payer: Cofinity Medicare Advantage	$2.84
Rate for Payer: Encore Health Key Benefits Commercial	$3.25
Rate for Payer: Healthscope Commercial	$3.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.45
Rate for Payer: PHP Commercial	$3.45
Rate for Payer: Priority Health Cigna Priority Health	$2.64
Rate for Payer: Priority Health SBD	$2.56

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$28.66

Service Code	NDC 60505700900
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$11.46
Max. Negotiated Rate	$25.79
Rate for Payer: Aetna Commercial	$24.36
Rate for Payer: Aetna Medicare	$14.33
Rate for Payer: Aetna New Business (MI Preferred)	$18.63
Rate for Payer: BCBS Complete	$11.46
Rate for Payer: Cash Price	$22.93
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Cofinity Medicare Advantage	$20.06
Rate for Payer: Encore Health Key Benefits Commercial	$22.93
Rate for Payer: Healthscope Commercial	$25.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.36
Rate for Payer: PHP Commercial	$24.36
Rate for Payer: Priority Health Cigna Priority Health	$18.63
Rate for Payer: Priority Health SBD	$18.06

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$59.54

Service Code	NDC 60505708400
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$23.82
Max. Negotiated Rate	$53.59
Rate for Payer: Aetna Commercial	$50.61
Rate for Payer: Aetna Medicare	$29.77
Rate for Payer: Aetna New Business (MI Preferred)	$38.70
Rate for Payer: BCBS Complete	$23.82
Rate for Payer: Cash Price	$47.63
Rate for Payer: Cofinity Commercial	$41.68
Rate for Payer: Cofinity Commercial	$51.20
Rate for Payer: Cofinity Medicare Advantage	$41.68
Rate for Payer: Encore Health Key Benefits Commercial	$47.63
Rate for Payer: Healthscope Commercial	$53.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.61
Rate for Payer: PHP Commercial	$50.61
Rate for Payer: Priority Health Cigna Priority Health	$38.70
Rate for Payer: Priority Health SBD	$37.51

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$143.29

Service Code	NDC 60505700902
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$57.32
Max. Negotiated Rate	$128.96
Rate for Payer: Aetna Commercial	$121.80
Rate for Payer: Aetna Medicare	$71.64
Rate for Payer: Aetna New Business (MI Preferred)	$93.14
Rate for Payer: BCBS Complete	$57.32
Rate for Payer: Cash Price	$114.63
Rate for Payer: Cofinity Commercial	$100.30
Rate for Payer: Cofinity Commercial	$123.23
Rate for Payer: Cofinity Medicare Advantage	$100.30
Rate for Payer: Encore Health Key Benefits Commercial	$114.63
Rate for Payer: Healthscope Commercial	$128.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.80
Rate for Payer: PHP Commercial	$121.80
Rate for Payer: Priority Health Cigna Priority Health	$93.14
Rate for Payer: Priority Health SBD	$90.27

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$143.29

Service Code	NDC 60505700902
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: Cofinity Medicare Advantage	$100.30
Rate for Payer: Encore Health Key Benefits Commercial	$114.63
Rate for Payer: Healthscope Commercial	$128.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.80
Rate for Payer: PHP Commercial	$121.80
Rate for Payer: Priority Health Cigna Priority Health	$93.14
Rate for Payer: Priority Health SBD	$90.27

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$297.70

Service Code	NDC 60505708402
Hospital Charge Code	27908
Hospital Revenue Code	637
Min. Negotiated Rate	$119.08
Max. Negotiated Rate	$267.93
Rate for Payer: Aetna Commercial	$253.04
Rate for Payer: Aetna Medicare	$148.85
Rate for Payer: Aetna New Business (MI Preferred)	$193.50
Rate for Payer: BCBS Complete	$119.08
Rate for Payer: Cash Price	$238.16
Rate for Payer: Cofinity Commercial	$208.39
Rate for Payer: Cofinity Commercial	$256.02
Rate for Payer: Cofinity Medicare Advantage	$208.39
Rate for Payer: Encore Health Key Benefits Commercial	$238.16
Rate for Payer: Healthscope Commercial	$267.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.04
Rate for Payer: PHP Commercial	$253.04
Rate for Payer: Priority Health Cigna Priority Health	$193.50
Rate for Payer: Priority Health SBD	$187.55

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$59.54

Service Code	NDC 60505708400
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: Cofinity Medicare Advantage	$41.68
Rate for Payer: Encore Health Key Benefits Commercial	$47.63
Rate for Payer: Healthscope Commercial	$53.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.61
Rate for Payer: PHP Commercial	$50.61
Rate for Payer: Priority Health Cigna Priority Health	$38.70
Rate for Payer: Priority Health SBD	$37.51

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$297.70

Service Code	NDC 60505708402
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: Cofinity Medicare Advantage	$208.39
Rate for Payer: Encore Health Key Benefits Commercial	$238.16
Rate for Payer: Healthscope Commercial	$267.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$253.04
Rate for Payer: PHP Commercial	$253.04
Rate for Payer: Priority Health Cigna Priority Health	$193.50
Rate for Payer: Priority Health SBD	$187.55

FENTANYL 100 MCG/HR TRANSDERMAL PATCH

Facility

$28.66

Service Code	NDC 60505700900
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: Cofinity Medicare Advantage	$20.06
Rate for Payer: Encore Health Key Benefits Commercial	$22.93
Rate for Payer: Healthscope Commercial	$25.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.36
Rate for Payer: PHP Commercial	$24.36
Rate for Payer: Priority Health Cigna Priority Health	$18.63
Rate for Payer: Priority Health SBD	$18.06

FENTANYL 12 MCG/HR TRANSDERMAL PATCH

Facility

$262.19

Service Code	NDC 00378911998
Hospital Charge Code	41382
Hospital Revenue Code	637
Min. Negotiated Rate	$104.88
Max. Negotiated Rate	$235.97
Rate for Payer: Aetna Commercial	$222.86
Rate for Payer: Aetna Medicare	$131.09
Rate for Payer: Aetna New Business (MI Preferred)	$170.42
Rate for Payer: BCBS Complete	$104.88
Rate for Payer: Cash Price	$209.75
Rate for Payer: Cofinity Commercial	$183.53
Rate for Payer: Cofinity Commercial	$225.48
Rate for Payer: Cofinity Medicare Advantage	$183.53
Rate for Payer: Encore Health Key Benefits Commercial	$209.75
Rate for Payer: Healthscope Commercial	$235.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.86
Rate for Payer: PHP Commercial	$222.86
Rate for Payer: Priority Health Cigna Priority Health	$170.42
Rate for Payer: Priority Health SBD	$165.18

Know your out-of-pocket cost for care.

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