|
MOLASSES
|
Facility
|
OP
|
$6.48
|
|
|
Service Code
|
NDC 09900001118
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.21
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Advantage |
$4.54
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.86
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health SBD |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.21
|
| Rate for Payer: UHC Core |
$3.38
|
| Rate for Payer: UHC Exchange |
$2.55
|
|
|
MOLASSES
|
Facility
|
IP
|
$6.48
|
|
|
Service Code
|
NDC 09900001118
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$5.83 |
| Rate for Payer: Aetna Commercial |
$5.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.21
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cofinity Advantage |
$4.54
|
| Rate for Payer: Cofinity Commercial |
$5.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.86
|
| Rate for Payer: PHP Commercial |
$5.51
|
| Rate for Payer: Priority Health SBD |
$4.08
|
|
|
MONALISA TOUCH, SERIES, UP TO 3 VISITS
|
Professional
|
Both
|
$1,891.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$756.40 |
| Max. Negotiated Rate |
$1,418.25 |
| Rate for Payer: Aetna Medicare |
$945.50
|
| Rate for Payer: BCBS Complete |
$756.40
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,229.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,418.25
|
|
|
MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES
|
Professional
|
Both
|
$630.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$119.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: BCBS Complete |
$95.38
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Advantage |
$166.91
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.84
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health SBD |
$150.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.99
|
| Rate for Payer: UHC Core |
$124.23
|
| Rate for Payer: UHC Exchange |
$93.71
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.22 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.99
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Advantage |
$166.91
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.84
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health SBD |
$150.22
|
|
|
MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 09900000720
|
| Hospital Charge Code |
165001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Advantage |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.44
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health SBD |
$0.37
|
|
|
MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 09900000720
|
| Hospital Charge Code |
165001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.53 |
| Rate for Payer: Aetna Commercial |
$0.50
|
| Rate for Payer: Aetna Medicare |
$0.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.38
|
| Rate for Payer: BCBS Complete |
$0.24
|
| Rate for Payer: Cash Price |
$0.47
|
| Rate for Payer: Cofinity Advantage |
$0.41
|
| Rate for Payer: Cofinity Commercial |
$0.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.44
|
| Rate for Payer: PHP Commercial |
$0.50
|
| Rate for Payer: Priority Health SBD |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.38
|
| Rate for Payer: UHC Core |
$0.31
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION
|
Facility
|
IP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cofinity Advantage |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health SBD |
$143.32
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION
|
Facility
|
OP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: BCBS Complete |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$33.83
|
| Rate for Payer: BCN Commercial |
$33.83
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cofinity Advantage |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION (BBC)
|
Facility
|
IP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
301224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cofinity Advantage |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health SBD |
$143.32
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION (BBC)
|
Facility
|
OP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
301224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: BCBS Complete |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$33.83
|
| Rate for Payer: BCN Commercial |
$33.83
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cofinity Advantage |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
|
|
MORPHINE 100MG/100ML PCA IV SOLUTION
|
Facility
|
IP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cofinity Advantage |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health SBD |
$143.32
|
|
|
MORPHINE 100MG/100ML PCA IV SOLUTION
|
Facility
|
OP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: BCBS Complete |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$33.83
|
| Rate for Payer: BCN Commercial |
$33.83
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cofinity Advantage |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.28
|
| Rate for Payer: UHC Core |
$22.28
|
| Rate for Payer: UHC Exchange |
$22.28
|
|
|
MORPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$33.73
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.25 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cofinity Advantage |
$23.61
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.98
|
| Rate for Payer: Healthscope Commercial |
$30.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.30
|
| Rate for Payer: PHP Commercial |
$28.67
|
| Rate for Payer: Priority Health SBD |
$21.25
|
|
|
MORPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$33.73
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna Medicare |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: BCBS Complete |
$13.49
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cofinity Advantage |
$23.61
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.98
|
| Rate for Payer: Healthscope Commercial |
$30.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.30
|
| Rate for Payer: PHP Commercial |
$28.67
|
| Rate for Payer: Priority Health SBD |
$21.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.17
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: UHC Exchange |
$11.17
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health SBD |
$11.01
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.47
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$32.49
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
172788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cofinity Advantage |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$27.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.37
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health SBD |
$20.47
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$32.49
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
172788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna Medicare |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: BCBS Complete |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cash Price |
$25.99
|
| Rate for Payer: Cofinity Advantage |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$27.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.99
|
| Rate for Payer: Healthscope Commercial |
$29.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.37
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health SBD |
$20.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Advantage |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.39
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: Priority Health SBD |
$10.41
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: BCBS Complete |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Advantage |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.39
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: Priority Health SBD |
$10.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$5.02
|
| Rate for Payer: UHC Exchange |
$5.02
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
NDC 67877067001
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$392.49 |
| Max. Negotiated Rate |
$560.70 |
| Rate for Payer: Aetna Commercial |
$529.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.95
|
| Rate for Payer: Cash Price |
$498.40
|
| Rate for Payer: Cofinity Advantage |
$436.10
|
| Rate for Payer: Cofinity Commercial |
$535.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$498.40
|
| Rate for Payer: Healthscope Commercial |
$560.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$529.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$467.25
|
| Rate for Payer: PHP Commercial |
$529.55
|
| Rate for Payer: Priority Health SBD |
$392.49
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$527.10
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.15 |
| Max. Negotiated Rate |
$474.39 |
| Rate for Payer: Aetna Commercial |
$448.04
|
| Rate for Payer: Aetna Medicare |
$263.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.62
|
| Rate for Payer: BCBS Complete |
$210.84
|
| Rate for Payer: Cash Price |
$421.68
|
| Rate for Payer: Cofinity Advantage |
$368.97
|
| Rate for Payer: Cofinity Commercial |
$453.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.68
|
| Rate for Payer: Healthscope Commercial |
$474.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$421.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.32
|
| Rate for Payer: PHP Commercial |
$448.04
|
| Rate for Payer: Priority Health SBD |
$332.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.62
|
| Rate for Payer: UHC Core |
$274.62
|
| Rate for Payer: UHC Exchange |
$207.15
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$123.38
|
|
|
Service Code
|
NDC 00054023524
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.49 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: Aetna Medicare |
$61.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.20
|
| Rate for Payer: BCBS Complete |
$49.35
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Advantage |
$86.37
|
| Rate for Payer: Cofinity Commercial |
$106.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$111.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.53
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: Priority Health SBD |
$77.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.20
|
| Rate for Payer: UHC Core |
$64.28
|
| Rate for Payer: UHC Exchange |
$48.49
|
|
