|
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 |
$14.39
|
| Rate for Payer: Aetna Medicare |
$12.90
|
| Rate for Payer: Aetna Medicare |
$8.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.78
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$13.54
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cofinity Advantage |
$11.85
|
| Rate for Payer: Cofinity Advantage |
$18.07
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.36
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$14.39
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: Priority Health SBD |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.17
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: UHC Core |
$11.17
|
| Rate for Payer: UHC Exchange |
$11.17
|
| Rate for Payer: UHC Exchange |
$11.17
|
|
|
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 Advantage |
$15.99
|
| Rate for Payer: Cofinity Advantage |
$18.73
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Cofinity Commercial |
$19.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.28
|
| 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: Opus (Opus Packaging Group) HMA |
$17.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.07
|
| Rate for Payer: PHP Commercial |
$19.42
|
| Rate for Payer: PHP Commercial |
$22.75
|
| Rate for Payer: Priority Health SBD |
$16.86
|
| Rate for Payer: Priority Health SBD |
$14.40
|
|
|
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 Advantage |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| 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: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$142.28
|
|
|
Service Code
|
NDC 00054051744
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.64 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$120.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.48
|
| Rate for Payer: Cash Price |
$113.82
|
| Rate for Payer: Cofinity Advantage |
$99.60
|
| Rate for Payer: Cofinity Commercial |
$122.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.82
|
| Rate for Payer: Healthscope Commercial |
$128.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.71
|
| Rate for Payer: PHP Commercial |
$120.94
|
| Rate for Payer: Priority Health SBD |
$89.64
|
|
|
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 |
$0.81 |
| 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 Advantage |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.76
|
| Rate for Payer: Priority Health SBD |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Core |
$1.08
|
| Rate for Payer: UHC Exchange |
$0.81
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
OP
|
$142.28
|
|
|
Service Code
|
NDC 00054051744
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$128.05 |
| Rate for Payer: Aetna Commercial |
$120.94
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.48
|
| Rate for Payer: BCBS Complete |
$56.91
|
| Rate for Payer: Cash Price |
$113.82
|
| Rate for Payer: Cofinity Advantage |
$99.60
|
| Rate for Payer: Cofinity Commercial |
$122.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.82
|
| Rate for Payer: Healthscope Commercial |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$106.71
|
| Rate for Payer: PHP Commercial |
$120.94
|
| Rate for Payer: Priority Health SBD |
$89.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.48
|
| Rate for Payer: UHC Core |
$74.13
|
| Rate for Payer: UHC Exchange |
$55.92
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Advantage |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.58
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health SBD |
$7.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.44
|
| Rate for Payer: UHC Core |
$5.96
|
| Rate for Payer: UHC Exchange |
$4.50
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.44
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Advantage |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.58
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health SBD |
$7.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.44
|
| Rate for Payer: UHC Core |
$5.96
|
| Rate for Payer: UHC Exchange |
$4.50
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.44
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Advantage |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.58
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health SBD |
$7.21
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.44
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.44
|
| Rate for Payer: Cash Price |
$9.15
|
| Rate for Payer: Cofinity Advantage |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.15
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.58
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: Priority Health SBD |
$7.21
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$561.75
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.90 |
| Max. Negotiated Rate |
$505.57 |
| Rate for Payer: Aetna Commercial |
$477.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.14
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cofinity Advantage |
$393.23
|
| Rate for Payer: Cofinity Commercial |
$483.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.40
|
| Rate for Payer: Healthscope Commercial |
$505.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.31
|
| Rate for Payer: PHP Commercial |
$477.49
|
| Rate for Payer: Priority Health SBD |
$353.90
|
|
|
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 |
$1.67 |
| 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 Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$1.67
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.86
|
|
|
Service Code
|
NDC 68084015711
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: Aetna Medicare |
$2.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.81
|
| Rate for Payer: BCBS Complete |
$2.34
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cofinity Advantage |
$4.10
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.69
|
| Rate for Payer: Healthscope Commercial |
$5.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.39
|
| Rate for Payer: PHP Commercial |
$4.98
|
| Rate for Payer: Priority Health SBD |
$3.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.81
|
| Rate for Payer: UHC Core |
$3.05
|
| Rate for Payer: UHC Exchange |
$2.30
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$585.20
|
|
|
Service Code
|
NDC 68084015701
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$368.68 |
| Max. Negotiated Rate |
$526.68 |
| Rate for Payer: Aetna Commercial |
$497.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.38
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Cofinity Advantage |
$409.64
|
| Rate for Payer: Cofinity Commercial |
$503.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.16
|
| Rate for Payer: Healthscope Commercial |
$526.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.90
|
| Rate for Payer: PHP Commercial |
$497.42
|
| Rate for Payer: Priority Health SBD |
$368.68
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$561.75
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.77 |
| Max. Negotiated Rate |
$505.57 |
| Rate for Payer: Aetna Commercial |
$477.49
|
| Rate for Payer: Aetna Medicare |
$280.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.14
|
| Rate for Payer: BCBS Complete |
$224.70
|
| Rate for Payer: Cash Price |
$449.40
|
| Rate for Payer: Cofinity Advantage |
$393.23
|
| Rate for Payer: Cofinity Commercial |
$483.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$449.40
|
| Rate for Payer: Healthscope Commercial |
$505.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.31
|
| Rate for Payer: PHP Commercial |
$477.49
|
| Rate for Payer: Priority Health SBD |
$353.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.14
|
| Rate for Payer: UHC Core |
$292.67
|
| Rate for Payer: UHC Exchange |
$220.77
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$585.20
|
|
|
Service Code
|
NDC 68084015701
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.98 |
| Max. Negotiated Rate |
$526.68 |
| Rate for Payer: Aetna Commercial |
$497.42
|
| Rate for Payer: Aetna Medicare |
$292.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.38
|
| Rate for Payer: BCBS Complete |
$234.08
|
| Rate for Payer: Cash Price |
$468.16
|
| Rate for Payer: Cofinity Advantage |
$409.64
|
| Rate for Payer: Cofinity Commercial |
$503.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$468.16
|
| Rate for Payer: Healthscope Commercial |
$526.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$468.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.90
|
| Rate for Payer: PHP Commercial |
$497.42
|
| Rate for Payer: Priority Health SBD |
$368.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.38
|
| Rate for Payer: UHC Core |
$304.89
|
| Rate for Payer: UHC Exchange |
$229.98
|
|
|
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 Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| 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: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.86
|
|
|
Service Code
|
NDC 68084015711
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.69 |
| Max. Negotiated Rate |
$5.27 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.81
|
| Rate for Payer: Cash Price |
$4.69
|
| Rate for Payer: Cofinity Advantage |
$4.10
|
| Rate for Payer: Cofinity Commercial |
$5.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.69
|
| Rate for Payer: Healthscope Commercial |
$5.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.39
|
| Rate for Payer: PHP Commercial |
$4.98
|
| Rate for Payer: Priority Health SBD |
$3.69
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.08 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna Medicare |
$266.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.80
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Advantage |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$457.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.60
|
| Rate for Payer: Healthscope Commercial |
$478.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$399.00
|
| Rate for Payer: PHP Commercial |
$452.20
|
| Rate for Payer: Priority Health SBD |
$335.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.80
|
| Rate for Payer: UHC Core |
$277.17
|
| Rate for Payer: UHC Exchange |
$209.08
|
|
|
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 Advantage |
$296.94
|
| Rate for Payer: Cofinity Commercial |
$364.81
|
| 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: Opus (Opus Packaging Group) HMA |
$318.15
|
| Rate for Payer: PHP Commercial |
$360.57
|
| Rate for Payer: Priority Health SBD |
$267.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$586.60
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$527.94 |
| Rate for Payer: Aetna Commercial |
$498.61
|
| Rate for Payer: Aetna Medicare |
$293.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.29
|
| Rate for Payer: BCBS Complete |
$234.64
|
| Rate for Payer: Cash Price |
$469.28
|
| Rate for Payer: Cofinity Advantage |
$410.62
|
| Rate for Payer: Cofinity Commercial |
$504.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.28
|
| Rate for Payer: Healthscope Commercial |
$527.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$469.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.95
|
| Rate for Payer: PHP Commercial |
$498.61
|
| Rate for Payer: Priority Health SBD |
$369.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.29
|
| Rate for Payer: UHC Core |
$305.62
|
| Rate for Payer: UHC Exchange |
$230.53
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$586.60
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.56 |
| Max. Negotiated Rate |
$527.94 |
| Rate for Payer: Aetna Commercial |
$498.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.29
|
| Rate for Payer: Cash Price |
$469.28
|
| Rate for Payer: Cofinity Advantage |
$410.62
|
| Rate for Payer: Cofinity Commercial |
$504.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.28
|
| Rate for Payer: Healthscope Commercial |
$527.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.95
|
| Rate for Payer: PHP Commercial |
$498.61
|
| Rate for Payer: Priority Health SBD |
$369.56
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.87
|
|
|
Service Code
|
NDC 00406831523
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.82
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Advantage |
$4.11
|
| Rate for Payer: Cofinity Commercial |
$5.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.99
|
| Rate for Payer: Priority Health SBD |
$3.70
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.87
|
|
|
Service Code
|
NDC 00406831523
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.82
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Advantage |
$4.11
|
| Rate for Payer: Cofinity Commercial |
$5.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.99
|
| Rate for Payer: Priority Health SBD |
$3.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.82
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: UHC Exchange |
$2.31
|
|
|
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 |
$166.71 |
| 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 Advantage |
$296.94
|
| Rate for Payer: Cofinity Commercial |
$364.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.36
|
| Rate for Payer: Healthscope Commercial |
$381.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$339.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$318.15
|
| Rate for Payer: PHP Commercial |
$360.57
|
| Rate for Payer: Priority Health SBD |
$267.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.73
|
| Rate for Payer: UHC Core |
$221.01
|
| Rate for Payer: UHC Exchange |
$166.71
|
|
