|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$159.99
|
|
|
Service Code
|
NDC 00904716104
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.35 |
| Max. Negotiated Rate |
$143.99 |
| Rate for Payer: Aetna Commercial |
$135.99
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$132.14
|
| Rate for Payer: Cash Price |
$127.99
|
| Rate for Payer: Cofinity Commercial |
$137.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.99
|
| Rate for Payer: Healthscope Commercial |
$143.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.99
|
| Rate for Payer: Nomi Health Commercial |
$131.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.99
|
| Rate for Payer: PHP Commercial |
$135.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$139.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.79
|
| Rate for Payer: UHC Core |
$133.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.99
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$207.36
|
|
|
Service Code
|
NDC 00904748004
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$186.62 |
| Rate for Payer: Aetna Commercial |
$176.26
|
| Rate for Payer: BCBS Trust/PPO |
$171.26
|
| Rate for Payer: BCN Commercial |
$171.26
|
| Rate for Payer: Cash Price |
$165.89
|
| Rate for Payer: Cofinity Commercial |
$178.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.89
|
| Rate for Payer: Healthscope Commercial |
$186.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.26
|
| Rate for Payer: Nomi Health Commercial |
$170.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.52
|
| Rate for Payer: PHP Commercial |
$176.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.48
|
| Rate for Payer: UHC Core |
$173.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.52
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$8.81
|
|
|
Service Code
|
NDC 60687062911
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$7.93 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.28
|
| Rate for Payer: BCN Commercial |
$7.28
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Cofinity Commercial |
$7.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.05
|
| Rate for Payer: Healthscope Commercial |
$7.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.49
|
| Rate for Payer: Nomi Health Commercial |
$7.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.61
|
| Rate for Payer: PHP Commercial |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.75
|
| Rate for Payer: UHC Core |
$7.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$120.82
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.09 |
| Max. Negotiated Rate |
$108.74 |
| Rate for Payer: Aetna Commercial |
$102.70
|
| Rate for Payer: BCBS Trust/PPO |
$99.79
|
| Rate for Payer: BCN Commercial |
$99.79
|
| Rate for Payer: Cash Price |
$96.66
|
| Rate for Payer: Cofinity Commercial |
$103.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.66
|
| Rate for Payer: Healthscope Commercial |
$108.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Nomi Health Commercial |
$99.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.61
|
| Rate for Payer: PHP Commercial |
$102.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.32
|
| Rate for Payer: UHC Core |
$100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$120.82
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$108.74 |
| Rate for Payer: Aetna Commercial |
$102.70
|
| Rate for Payer: Aetna Medicare |
$31.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.76
|
| Rate for Payer: BCBS Complete |
$22.36
|
| Rate for Payer: BCBS MAPPO |
$30.20
|
| Rate for Payer: BCBS Trust/PPO |
$99.33
|
| Rate for Payer: BCN Commercial |
$99.33
|
| Rate for Payer: BCN Medicare Advantage |
$30.20
|
| Rate for Payer: Cash Price |
$96.66
|
| Rate for Payer: Cofinity Commercial |
$103.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$108.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.61
|
| Rate for Payer: Mclaren Medicaid |
$21.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.72
|
| Rate for Payer: Meridian Medicaid |
$22.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Nomi Health Commercial |
$99.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.61
|
| Rate for Payer: PACE Senior Care Partners |
$28.69
|
| Rate for Payer: PACE SWMI |
$30.20
|
| Rate for Payer: PHP Commercial |
$102.70
|
| Rate for Payer: PHP Medicare Advantage |
$30.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$105.11
|
| Rate for Payer: Priority Health Medicare |
$30.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.09
|
| Rate for Payer: Railroad Medicare Medicare |
$30.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.32
|
| Rate for Payer: UHC Core |
$100.88
|
| Rate for Payer: UHC Exchange |
$30.20
|
| Rate for Payer: UHC Medicaid |
$21.30
|
| Rate for Payer: UHC Medicare Advantage |
$30.20
|
| Rate for Payer: UHCCP Medicaid |
$21.30
|
| Rate for Payer: VA VA |
$30.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.61
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: BCBS Trust/PPO |
$179.92
|
| Rate for Payer: BCN Commercial |
$179.92
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Core |
$181.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.41 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.08
|
| Rate for Payer: BCBS Complete |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$54.46
|
| Rate for Payer: BCBS Trust/PPO |
$179.09
|
| Rate for Payer: BCN Commercial |
$179.09
|
| Rate for Payer: BCN Medicare Advantage |
$54.46
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Mclaren Medicaid |
$38.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.19
|
| Rate for Payer: Meridian Medicaid |
$40.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PACE Senior Care Partners |
$51.74
|
| Rate for Payer: PACE SWMI |
$54.46
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: PHP Medicare Advantage |
$54.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Medicare |
$55.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.62
|
| Rate for Payer: Railroad Medicare Medicare |
$54.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Core |
$181.90
|
| Rate for Payer: UHC Exchange |
$54.46
|
| Rate for Payer: UHC Medicaid |
$38.41
|
| Rate for Payer: UHC Medicare Advantage |
$54.46
|
| Rate for Payer: UHCCP Medicaid |
$38.41
|
| Rate for Payer: VA VA |
$54.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$4.03
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: BCBS Trust/PPO |
$3.33
|
| Rate for Payer: BCN Commercial |
$3.33
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.55
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$4.03
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.26
|
| Rate for Payer: BCBS Complete |
$0.75
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Mclaren Medicaid |
$0.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Medicaid |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PACE Senior Care Partners |
$0.96
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Commercial |
$3.43
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.51
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.55
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Exchange |
$1.01
|
| Rate for Payer: UHC Medicaid |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UHCCP Medicaid |
$0.71
|
| Rate for Payer: VA VA |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$263.71
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$237.34 |
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: Aetna Medicare |
$68.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.41
|
| Rate for Payer: BCBS Complete |
$48.81
|
| Rate for Payer: BCBS MAPPO |
$65.93
|
| Rate for Payer: BCBS Trust/PPO |
$216.80
|
| Rate for Payer: BCN Commercial |
$216.80
|
| Rate for Payer: BCN Medicare Advantage |
$65.93
|
| Rate for Payer: Cash Price |
$210.97
|
| Rate for Payer: Cofinity Commercial |
$226.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.93
|
| Rate for Payer: Healthscope Commercial |
$237.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.78
|
| Rate for Payer: Mclaren Medicaid |
$46.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.22
|
| Rate for Payer: Meridian Medicaid |
$48.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.15
|
| Rate for Payer: Nomi Health Commercial |
$216.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.78
|
| Rate for Payer: PACE Senior Care Partners |
$62.63
|
| Rate for Payer: PACE SWMI |
$65.93
|
| Rate for Payer: PHP Commercial |
$224.15
|
| Rate for Payer: PHP Medicare Advantage |
$65.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$229.43
|
| Rate for Payer: Priority Health Medicare |
$66.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.54
|
| Rate for Payer: Railroad Medicare Medicare |
$65.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.06
|
| Rate for Payer: UHC Core |
$220.20
|
| Rate for Payer: UHC Exchange |
$65.93
|
| Rate for Payer: UHC Medicaid |
$46.49
|
| Rate for Payer: UHC Medicare Advantage |
$65.93
|
| Rate for Payer: UHCCP Medicaid |
$46.49
|
| Rate for Payer: VA VA |
$65.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.78
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$52.75
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.71 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cofinity Commercial |
$45.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$47.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.84
|
| Rate for Payer: Nomi Health Commercial |
$43.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.56
|
| Rate for Payer: PHP Commercial |
$44.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.42
|
| Rate for Payer: UHC Core |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.56
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$263.71
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.54 |
| Max. Negotiated Rate |
$237.34 |
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: BCBS Trust/PPO |
$217.80
|
| Rate for Payer: BCN Commercial |
$217.80
|
| Rate for Payer: Cash Price |
$210.97
|
| Rate for Payer: Cofinity Commercial |
$226.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.97
|
| Rate for Payer: Healthscope Commercial |
$237.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.15
|
| Rate for Payer: Nomi Health Commercial |
$216.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.78
|
| Rate for Payer: PHP Commercial |
$224.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$229.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.06
|
| Rate for Payer: UHC Core |
$220.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.78
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$52.75
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.48
|
| Rate for Payer: BCBS Complete |
$9.76
|
| Rate for Payer: BCBS MAPPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$43.37
|
| Rate for Payer: BCN Commercial |
$43.37
|
| Rate for Payer: BCN Medicare Advantage |
$13.19
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cofinity Commercial |
$45.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.19
|
| Rate for Payer: Healthscope Commercial |
$47.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.56
|
| Rate for Payer: Mclaren Medicaid |
$9.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.85
|
| Rate for Payer: Meridian Medicaid |
$9.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.84
|
| Rate for Payer: Nomi Health Commercial |
$43.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.56
|
| Rate for Payer: PACE Senior Care Partners |
$12.53
|
| Rate for Payer: PACE SWMI |
$13.19
|
| Rate for Payer: PHP Commercial |
$44.84
|
| Rate for Payer: PHP Medicare Advantage |
$13.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.89
|
| Rate for Payer: Priority Health Medicare |
$13.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.42
|
| Rate for Payer: UHC Core |
$44.05
|
| Rate for Payer: UHC Exchange |
$13.19
|
| Rate for Payer: UHC Medicaid |
$9.30
|
| Rate for Payer: UHC Medicare Advantage |
$13.19
|
| Rate for Payer: UHCCP Medicaid |
$9.30
|
| Rate for Payer: VA VA |
$13.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.56
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 50742055001
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.73
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$109.40
|
|
|
Service Code
|
NDC 00406912576
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna Medicare |
$28.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.19
|
| Rate for Payer: BCBS Complete |
$20.25
|
| Rate for Payer: BCBS MAPPO |
$27.35
|
| Rate for Payer: BCBS Trust/PPO |
$89.94
|
| Rate for Payer: BCN Commercial |
$89.94
|
| Rate for Payer: BCN Medicare Advantage |
$27.35
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.35
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.05
|
| Rate for Payer: Mclaren Medicaid |
$19.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.72
|
| Rate for Payer: Meridian Medicaid |
$20.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Nomi Health Commercial |
$89.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PACE Senior Care Partners |
$25.98
|
| Rate for Payer: PACE SWMI |
$27.35
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: PHP Medicare Advantage |
$27.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.18
|
| Rate for Payer: Priority Health Medicare |
$27.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.14
|
| Rate for Payer: Railroad Medicare Medicare |
$27.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.27
|
| Rate for Payer: UHC Core |
$91.35
|
| Rate for Payer: UHC Exchange |
$27.35
|
| Rate for Payer: UHC Medicaid |
$19.29
|
| Rate for Payer: UHC Medicare Advantage |
$27.35
|
| Rate for Payer: UHCCP Medicaid |
$19.29
|
| Rate for Payer: VA VA |
$27.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.05
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$95.16
|
|
|
Service Code
|
NDC 50742055005
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Aetna Medicare |
$24.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.74
|
| Rate for Payer: BCBS Complete |
$17.61
|
| Rate for Payer: BCBS MAPPO |
$23.79
|
| Rate for Payer: BCBS Trust/PPO |
$78.23
|
| Rate for Payer: BCN Commercial |
$78.23
|
| Rate for Payer: BCN Medicare Advantage |
$23.79
|
| Rate for Payer: Cash Price |
$76.13
|
| Rate for Payer: Cofinity Commercial |
$81.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.79
|
| Rate for Payer: Healthscope Commercial |
$85.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.37
|
| Rate for Payer: Mclaren Medicaid |
$16.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.98
|
| Rate for Payer: Meridian Medicaid |
$17.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Nomi Health Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.37
|
| Rate for Payer: PACE Senior Care Partners |
$22.60
|
| Rate for Payer: PACE SWMI |
$23.79
|
| Rate for Payer: PHP Commercial |
$80.89
|
| Rate for Payer: PHP Medicare Advantage |
$23.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$82.79
|
| Rate for Payer: Priority Health Medicare |
$24.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.23
|
| Rate for Payer: Railroad Medicare Medicare |
$23.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.74
|
| Rate for Payer: UHC Core |
$79.46
|
| Rate for Payer: UHC Exchange |
$23.79
|
| Rate for Payer: UHC Medicaid |
$16.78
|
| Rate for Payer: UHC Medicare Advantage |
$23.79
|
| Rate for Payer: UHCCP Medicaid |
$16.78
|
| Rate for Payer: VA VA |
$23.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.37
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$109.40
|
|
|
Service Code
|
NDC 00406912576
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.14 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: BCBS Trust/PPO |
$90.35
|
| Rate for Payer: BCN Commercial |
$90.35
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Nomi Health Commercial |
$89.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.27
|
| Rate for Payer: UHC Core |
$91.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.05
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 50742055001
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare |
$4.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.95
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$4.76
|
| Rate for Payer: BCBS Trust/PPO |
$15.65
|
| Rate for Payer: BCN Commercial |
$15.65
|
| Rate for Payer: BCN Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Mclaren Medicaid |
$3.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.00
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Nomi Health Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: PACE Senior Care Partners |
$4.52
|
| Rate for Payer: PACE SWMI |
$4.76
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: PHP Medicare Advantage |
$4.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.56
|
| Rate for Payer: Priority Health Medicare |
$4.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$15.90
|
| Rate for Payer: UHC Exchange |
$4.76
|
| Rate for Payer: UHC Medicaid |
$3.36
|
| Rate for Payer: UHC Medicare Advantage |
$4.76
|
| Rate for Payer: UHCCP Medicaid |
$3.36
|
| Rate for Payer: VA VA |
$4.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$95.16
|
|
|
Service Code
|
NDC 50742055005
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.23 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: BCBS Trust/PPO |
$78.59
|
| Rate for Payer: BCN Commercial |
$78.59
|
| Rate for Payer: Cash Price |
$76.13
|
| Rate for Payer: Cofinity Commercial |
$81.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.13
|
| Rate for Payer: Healthscope Commercial |
$85.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Nomi Health Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.37
|
| Rate for Payer: PHP Commercial |
$80.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$82.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.74
|
| Rate for Payer: UHC Core |
$79.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.37
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$26.85
|
|
|
Service Code
|
NDC 50742055201
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: BCBS Trust/PPO |
$22.18
|
| Rate for Payer: BCN Commercial |
$22.18
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Nomi Health Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.63
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.14
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$194.37
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Aetna Commercial |
$165.21
|
| Rate for Payer: BCBS Trust/PPO |
$160.53
|
| Rate for Payer: BCN Commercial |
$160.53
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cofinity Commercial |
$167.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$174.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.21
|
| Rate for Payer: Nomi Health Commercial |
$159.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.78
|
| Rate for Payer: PHP Commercial |
$165.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.05
|
| Rate for Payer: UHC Core |
$162.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.78
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$26.85
|
|
|
Service Code
|
NDC 50742055201
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.39
|
| Rate for Payer: BCBS Complete |
$4.97
|
| Rate for Payer: BCBS MAPPO |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$22.07
|
| Rate for Payer: BCN Commercial |
$22.07
|
| Rate for Payer: BCN Medicare Advantage |
$6.71
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.71
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.14
|
| Rate for Payer: Mclaren Medicaid |
$4.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.05
|
| Rate for Payer: Meridian Medicaid |
$4.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Nomi Health Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PACE Senior Care Partners |
$6.38
|
| Rate for Payer: PACE SWMI |
$6.71
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: PHP Medicare Advantage |
$6.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.36
|
| Rate for Payer: Priority Health Medicare |
$6.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| Rate for Payer: Railroad Medicare Medicare |
$6.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.63
|
| Rate for Payer: UHC Core |
$22.42
|
| Rate for Payer: UHC Exchange |
$6.71
|
| Rate for Payer: UHC Medicaid |
$4.73
|
| Rate for Payer: UHC Medicare Advantage |
$6.71
|
| Rate for Payer: UHCCP Medicaid |
$4.73
|
| Rate for Payer: VA VA |
$6.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.14
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$193.65
|
|
|
Service Code
|
NDC 00406905076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.78 |
| Max. Negotiated Rate |
$174.28 |
| Rate for Payer: Aetna Commercial |
$164.60
|
| Rate for Payer: BCBS Trust/PPO |
$159.94
|
| Rate for Payer: BCN Commercial |
$159.94
|
| Rate for Payer: Cash Price |
$154.92
|
| Rate for Payer: Cofinity Commercial |
$166.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.92
|
| Rate for Payer: Healthscope Commercial |
$174.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.60
|
| Rate for Payer: Nomi Health Commercial |
$158.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.24
|
| Rate for Payer: PHP Commercial |
$164.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$168.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.41
|
| Rate for Payer: UHC Core |
$161.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.24
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$38.88
|
|
|
Service Code
|
NDC 00378912216
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: BCBS Trust/PPO |
$32.11
|
| Rate for Payer: BCN Commercial |
$32.11
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Cofinity Commercial |
$33.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.10
|
| Rate for Payer: Healthscope Commercial |
$34.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.05
|
| Rate for Payer: Nomi Health Commercial |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.16
|
| Rate for Payer: PHP Commercial |
$33.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.21
|
| Rate for Payer: UHC Core |
$32.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.16
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$193.65
|
|
|
Service Code
|
NDC 00406905076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$174.28 |
| Rate for Payer: Aetna Commercial |
$164.60
|
| Rate for Payer: Aetna Medicare |
$50.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.52
|
| Rate for Payer: BCBS Complete |
$35.84
|
| Rate for Payer: BCBS MAPPO |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$159.20
|
| Rate for Payer: BCN Commercial |
$159.20
|
| Rate for Payer: BCN Medicare Advantage |
$48.41
|
| Rate for Payer: Cash Price |
$154.92
|
| Rate for Payer: Cofinity Commercial |
$166.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.41
|
| Rate for Payer: Healthscope Commercial |
$174.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.24
|
| Rate for Payer: Mclaren Medicaid |
$34.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.83
|
| Rate for Payer: Meridian Medicaid |
$35.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.60
|
| Rate for Payer: Nomi Health Commercial |
$158.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.24
|
| Rate for Payer: PACE Senior Care Partners |
$45.99
|
| Rate for Payer: PACE SWMI |
$48.41
|
| Rate for Payer: PHP Commercial |
$164.60
|
| Rate for Payer: PHP Medicare Advantage |
$48.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$168.48
|
| Rate for Payer: Priority Health Medicare |
$48.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.78
|
| Rate for Payer: Railroad Medicare Medicare |
$48.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.41
|
| Rate for Payer: UHC Core |
$161.70
|
| Rate for Payer: UHC Exchange |
$48.41
|
| Rate for Payer: UHC Medicaid |
$34.14
|
| Rate for Payer: UHC Medicare Advantage |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$34.14
|
| Rate for Payer: VA VA |
$48.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.24
|
|
