|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.19
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.18 |
| Max. Negotiated Rate |
$235.97 |
| Rate for Payer: Aetna Commercial |
$222.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| 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
|
|
|
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 |
$43.76 |
| 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 Commercial |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.11
|
| Rate for Payer: Priority Health SBD |
$68.92
|
|
|
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 |
$8.75 |
| 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 Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.32
|
| 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: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$13.78
|
|
|
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 Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.32
|
| 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: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$13.78
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$109.40
|
|
|
Service Code
|
NDC 47781042447
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.11
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Commercial |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.11
|
| Rate for Payer: Priority Health SBD |
$68.92
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$30.08
|
|
|
Service Code
|
NDC 60505708200
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Medicare |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.55
|
| Rate for Payer: BCBS Complete |
$12.03
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cofinity Commercial |
$21.06
|
| Rate for Payer: Cofinity Commercial |
$25.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.06
|
| Rate for Payer: Healthscope Commercial |
$27.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.57
|
| Rate for Payer: PHP Commercial |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.55
|
| Rate for Payer: Priority Health SBD |
$18.95
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$30.08
|
|
|
Service Code
|
NDC 60505708200
|
| 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: Cofinity Medicare Advantage |
$21.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.06
|
| Rate for Payer: Healthscope Commercial |
$27.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.57
|
| Rate for Payer: PHP Commercial |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.55
|
| Rate for Payer: Priority Health SBD |
$18.95
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$150.39
|
|
|
Service Code
|
NDC 60505708202
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: Aetna Medicare |
$75.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.75
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$105.27
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.75
|
| Rate for Payer: Priority Health SBD |
$94.75
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
NDC 60505708202
|
| 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: Cofinity Medicare Advantage |
$105.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.75
|
| Rate for Payer: Priority Health SBD |
$94.75
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
IP
|
$17.56
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| 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 |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| 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 Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$9.07
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
OP
|
$14.39
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| 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: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Complete |
$8.39
|
| 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 Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| 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 |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| 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 |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$9.07
|
|
|
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 |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$87.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.35
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: Priority Health SBD |
$78.85
|
|
|
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 |
$32.40 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Commercial |
$106.39
|
| Rate for Payer: Aetna Medicare |
$62.58
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.35
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$50.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$87.61
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.39
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| 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
|
$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 Commercial |
$16.66
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.66
|
| 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: PHP Commercial |
$20.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.47
|
| Rate for Payer: Priority Health SBD |
$14.99
|
|
|
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 |
$40.60 |
| 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 Commercial |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.05
|
| 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: PHP Commercial |
$86.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.97
|
| Rate for Payer: Priority Health SBD |
$63.95
|
|
|
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 Commercial |
$71.05
|
| Rate for Payer: Cofinity Commercial |
$87.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.05
|
| 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: PHP Commercial |
$86.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.97
|
| 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 |
$9.52 |
| 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 Commercial |
$16.66
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.66
|
| 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: PHP Commercial |
$20.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.47
|
| Rate for Payer: Priority Health SBD |
$14.99
|
|
|
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 Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.09
|
| 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: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
|
|
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 |
$8.62 |
| 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: Cash Price |
$17.24
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.09
|
| 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: PHP Commercial |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.49
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$25.64 |
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Commercial |
$37.83
|
| Rate for Payer: Aetna Commercial |
$43.52
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$29.41
|
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna Medicare |
$25.60
|
| Rate for Payer: Aetna Medicare |
$9.35
|
| Rate for Payer: Aetna Medicare |
$22.33
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna Medicare |
$12.36
|
| Rate for Payer: Aetna Medicare |
$18.05
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna Medicare |
$19.75
|
| Rate for Payer: Aetna Medicare |
$7.42
|
| Rate for Payer: Aetna Medicare |
$8.07
|
| Rate for Payer: Aetna Medicare |
$15.82
|
| Rate for Payer: Aetna Medicare |
$17.30
|
| Rate for Payer: Aetna Medicare |
$4.92
|
| Rate for Payer: Aetna Medicare |
$22.25
|
| Rate for Payer: Aetna Medicare |
$4.91
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.07
|
| 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) |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: BCBS Complete |
$6.46
|
| Rate for Payer: BCBS Complete |
$12.66
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Complete |
$5.44
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$3.94
|
| Rate for Payer: BCBS Complete |
$3.92
|
| Rate for Payer: BCBS Complete |
$20.48
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS Complete |
$17.80
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS Complete |
$15.80
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$14.44
|
| Rate for Payer: BCBS Complete |
$9.89
|
| Rate for Payer: BCBS Complete |
$13.84
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$35.73
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$12.91
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$9.53
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$29.76
|
| Rate for Payer: Cofinity Commercial |
$24.22
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$16.07
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$33.97
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$27.65
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| 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 |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.60
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Healthscope Commercial |
$46.08
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.96
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$37.83
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$29.41
|
| Rate for Payer: PHP Commercial |
$37.96
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: PHP Commercial |
$13.72
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$30.68
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$43.52
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health SBD |
$6.18
|
| Rate for Payer: Priority Health SBD |
$19.93
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$21.80
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: Priority Health SBD |
$22.74
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$10.17
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: Priority Health SBD |
$28.14
|
| Rate for Payer: Priority Health SBD |
$32.26
|
| Rate for Payer: Priority Health SBD |
$17.95
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.39
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: Aetna Commercial |
$29.41
|
| Rate for Payer: Aetna Commercial |
$30.68
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$33.58
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$37.83
|
| Rate for Payer: Aetna Commercial |
$15.89
|
| Rate for Payer: Aetna Commercial |
$37.96
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$43.52
|
| Rate for Payer: Aetna Commercial |
$8.34
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| 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) |
$33.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.68
|
| 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) |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cash Price |
$40.96
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$7.85
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$12.91
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$35.60
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$11.87
|
| Rate for Payer: Cash Price |
$31.60
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$35.73
|
| Rate for Payer: Cash Price |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$11.30
|
| Rate for Payer: Cofinity Commercial |
$44.03
|
| Rate for Payer: Cofinity Commercial |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$38.41
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$16.07
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$31.15
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$29.76
|
| Rate for Payer: Cofinity Commercial |
$33.97
|
| Rate for Payer: Cofinity Commercial |
$27.65
|
| Rate for Payer: Cofinity Commercial |
$24.22
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$31.05
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$10.39
|
| Rate for Payer: Cofinity Commercial |
$8.44
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$12.76
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Cofinity Commercial |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| 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 |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.96
|
| 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 |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$8.83
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$35.55
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$31.14
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Healthscope Commercial |
$46.08
|
| Rate for Payer: Healthscope Commercial |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Healthscope Commercial |
$32.49
|
| 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 |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$29.41
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$30.68
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$33.58
|
| Rate for Payer: PHP Commercial |
$15.89
|
| Rate for Payer: PHP Commercial |
$37.83
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$37.96
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$43.52
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$13.72
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$8.34
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.15
|
| Rate for Payer: Priority Health SBD |
$28.04
|
| Rate for Payer: Priority Health SBD |
$28.14
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: Priority Health SBD |
$10.17
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: Priority Health SBD |
$22.74
|
| Rate for Payer: Priority Health SBD |
$19.93
|
| Rate for Payer: Priority Health SBD |
$9.35
|
| Rate for Payer: Priority Health SBD |
$24.89
|
| Rate for Payer: Priority Health SBD |
$6.18
|
| Rate for Payer: Priority Health SBD |
$21.80
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: Priority Health SBD |
$32.26
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$17.95
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$6.21
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,185.43
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2,866.89 |
| Rate for Payer: Aetna Commercial |
$2,707.62
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,070.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: BCBS Complete |
$0.62
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cofinity Commercial |
$2,739.47
|
| Rate for Payer: Cofinity Commercial |
$2,229.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,548.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$2,866.89
|
| Rate for Payer: Mclaren Medicaid |
$0.59
|
| Rate for Payer: Mclaren Medicare |
$1.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: Meridian Medicaid |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,707.62
|
| Rate for Payer: PACE Medicare |
$1.05
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$2,707.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.53
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health SBD |
$2,006.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: UHCCP Medicaid |
$0.62
|
| Rate for Payer: VA VA |
$1.11
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,185.43
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,006.82 |
| Max. Negotiated Rate |
$2,866.89 |
| Rate for Payer: Aetna Commercial |
$2,707.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,070.53
|
| Rate for Payer: Cash Price |
$2,548.34
|
| Rate for Payer: Cofinity Commercial |
$2,229.80
|
| Rate for Payer: Cofinity Commercial |
$2,739.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,229.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,548.34
|
| Rate for Payer: Healthscope Commercial |
$2,866.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,707.62
|
| Rate for Payer: PHP Commercial |
$2,707.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,070.53
|
| Rate for Payer: Priority Health SBD |
$2,006.82
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
OP
|
$54.17
|
|
|
Service Code
|
NDC 59365606501
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Medicare |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$21.67
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$34.13
|
|
|
FERRIC SUBSULFATE 259 MG/G TOPICAL SOLUTION
|
Facility
|
IP
|
$54.17
|
|
|
Service Code
|
NDC 59365606500
|
| Hospital Charge Code |
28357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.13 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: Cash Price |
$43.34
|
| Rate for Payer: Cofinity Commercial |
$37.92
|
| Rate for Payer: Cofinity Commercial |
$46.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.04
|
| Rate for Payer: PHP Commercial |
$46.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.21
|
| Rate for Payer: Priority Health SBD |
$34.13
|
|
