|
MORPHINE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$30.64
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
186563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Medicare |
$15.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.92
|
| Rate for Payer: BCBS Complete |
$12.26
|
| Rate for Payer: Cash Price |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$27.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.04
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.92
|
| Rate for Payer: Priority Health SBD |
$19.30
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$22.85
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$20.57 |
| Rate for Payer: Aetna Commercial |
$19.42
|
| Rate for Payer: Aetna Commercial |
$22.75
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.39
|
| Rate for Payer: BCBS Complete |
$9.14
|
| Rate for Payer: BCBS Complete |
$10.70
|
| Rate for Payer: Cash Price |
$21.41
|
| Rate for Payer: Cash Price |
$18.28
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Cofinity Commercial |
$19.65
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Cofinity Commercial |
$15.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$24.08
|
| Rate for Payer: Healthscope Commercial |
$20.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.75
|
| Rate for Payer: PHP Commercial |
$19.42
|
| Rate for Payer: PHP Commercial |
$22.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health SBD |
$14.40
|
| Rate for Payer: Priority Health SBD |
$16.86
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$26.76
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$24.08 |
| Rate for Payer: Aetna Commercial |
$22.75
|
| Rate for Payer: Aetna Commercial |
$19.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.39
|
| Rate for Payer: Cash Price |
$18.28
|
| Rate for Payer: Cash Price |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Cofinity Commercial |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$19.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$24.08
|
| Rate for Payer: Healthscope Commercial |
$20.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.75
|
| Rate for Payer: PHP Commercial |
$22.75
|
| Rate for Payer: PHP Commercial |
$19.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health SBD |
$14.40
|
| Rate for Payer: Priority Health SBD |
$16.86
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$25.81
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$13.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.28
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Cofinity Commercial |
$18.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.45
|
| Rate for Payer: PHP Commercial |
$13.45
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.78
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: Priority Health SBD |
$9.97
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$25.81
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$13.45
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.28
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Cofinity Commercial |
$13.61
|
| Rate for Payer: Cofinity Commercial |
$18.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.45
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.78
|
| Rate for Payer: Priority Health SBD |
$9.97
|
| Rate for Payer: Priority Health SBD |
$16.26
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$203.70
|
|
|
Service Code
|
NDC 00054051744
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Aetna Medicare |
$101.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.41
|
| Rate for Payer: BCBS Complete |
$81.48
|
| Rate for Payer: Cash Price |
$162.96
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$175.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.96
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.15
|
| Rate for Payer: PHP Commercial |
$173.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.41
|
| Rate for Payer: Priority Health SBD |
$128.33
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$203.70
|
|
|
Service Code
|
NDC 00054051744
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.41
|
| Rate for Payer: Cash Price |
$162.96
|
| Rate for Payer: Cofinity Commercial |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$175.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.96
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.15
|
| Rate for Payer: PHP Commercial |
$173.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.41
|
| Rate for Payer: Priority Health SBD |
$128.33
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
NDC 09900000410
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
NDC 09900000410
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 00406831523
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.22
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.90 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna Commercial |
$783.91
|
| Rate for Payer: Aetna Medicare |
$461.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.46
|
| Rate for Payer: BCBS Complete |
$368.90
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$645.58
|
| Rate for Payer: Cofinity Commercial |
$793.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Healthscope Commercial |
$830.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: PHP Commercial |
$783.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: Priority Health SBD |
$581.02
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 68084040311
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.68
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$424.20
|
|
|
Service Code
|
NDC 68084040301
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$381.78 |
| Rate for Payer: Aetna Commercial |
$360.57
|
| Rate for Payer: Aetna Medicare |
$212.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.73
|
| Rate for Payer: BCBS Complete |
$169.68
|
| Rate for Payer: Cash Price |
$339.36
|
| Rate for Payer: Cofinity Commercial |
$296.94
|
| Rate for Payer: Cofinity Commercial |
$364.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.36
|
| Rate for Payer: Healthscope Commercial |
$381.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.57
|
| Rate for Payer: PHP Commercial |
$360.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.73
|
| Rate for Payer: Priority Health SBD |
$267.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$424.20
|
|
|
Service Code
|
NDC 68084040301
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$381.78 |
| Rate for Payer: Aetna Commercial |
$360.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.73
|
| Rate for Payer: Cash Price |
$339.36
|
| Rate for Payer: Cofinity Commercial |
$296.94
|
| Rate for Payer: Cofinity Commercial |
$364.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.36
|
| Rate for Payer: Healthscope Commercial |
$381.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.57
|
| Rate for Payer: PHP Commercial |
$360.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.73
|
| Rate for Payer: Priority Health SBD |
$267.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 68084040311
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.68
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$581.02 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna Commercial |
$783.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.46
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$645.58
|
| Rate for Payer: Cofinity Commercial |
$793.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Healthscope Commercial |
$830.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: PHP Commercial |
$783.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: Priority Health SBD |
$581.02
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$255.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.15
|
| Rate for Payer: BCBS Complete |
$204.40
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.35
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: Priority Health SBD |
$321.93
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 00406831523
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.32
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health SBD |
$3.22
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.93 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.15
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.35
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: Priority Health SBD |
$321.93
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna Medicare |
$280.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
|
