|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$194.37
|
|
|
Service Code
|
NDC 00378912298
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Aetna Commercial |
$165.21
|
| Rate for Payer: Aetna Medicare |
$50.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.74
|
| Rate for Payer: BCBS Complete |
$35.98
|
| Rate for Payer: BCBS MAPPO |
$48.59
|
| Rate for Payer: BCBS Trust/PPO |
$159.79
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: BCN Medicare Advantage |
$48.59
|
| 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: Health Alliance Plan Medicare Advantage |
$48.59
|
| Rate for Payer: Healthscope Commercial |
$174.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.78
|
| Rate for Payer: Mclaren Medicaid |
$34.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.02
|
| Rate for Payer: Meridian Medicaid |
$35.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.45
|
| 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: PACE Senior Care Partners |
$46.16
|
| Rate for Payer: PACE SWMI |
$48.59
|
| Rate for Payer: PHP Commercial |
$165.21
|
| Rate for Payer: PHP Medicare Advantage |
$48.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.10
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.28
|
| Rate for Payer: Railroad Medicare Medicare |
$48.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.05
|
| Rate for Payer: UHC Core |
$162.30
|
| Rate for Payer: UHC Exchange |
$48.59
|
| Rate for Payer: UHC Medicaid |
$34.27
|
| Rate for Payer: UHC Medicare Advantage |
$48.59
|
| Rate for Payer: UHCCP Medicaid |
$34.27
|
| Rate for Payer: VA VA |
$48.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.78
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$194.37
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Aetna Commercial |
$165.21
|
| Rate for Payer: Aetna Medicare |
$50.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.74
|
| Rate for Payer: BCBS Complete |
$35.98
|
| Rate for Payer: BCBS MAPPO |
$48.59
|
| Rate for Payer: BCBS Trust/PPO |
$159.79
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: BCN Medicare Advantage |
$48.59
|
| 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: Health Alliance Plan Medicare Advantage |
$48.59
|
| Rate for Payer: Healthscope Commercial |
$174.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.78
|
| Rate for Payer: Mclaren Medicaid |
$34.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.02
|
| Rate for Payer: Meridian Medicaid |
$35.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.45
|
| 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: PACE Senior Care Partners |
$46.16
|
| Rate for Payer: PACE SWMI |
$48.59
|
| Rate for Payer: PHP Commercial |
$165.21
|
| Rate for Payer: PHP Medicare Advantage |
$48.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$169.10
|
| Rate for Payer: Priority Health Medicare |
$49.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.28
|
| Rate for Payer: Railroad Medicare Medicare |
$48.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.05
|
| Rate for Payer: UHC Core |
$162.30
|
| Rate for Payer: UHC Exchange |
$48.59
|
| Rate for Payer: UHC Medicaid |
$34.27
|
| Rate for Payer: UHC Medicare Advantage |
$48.59
|
| Rate for Payer: UHCCP Medicaid |
$34.27
|
| Rate for Payer: VA VA |
$48.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.78
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$38.88
|
|
|
Service Code
|
NDC 47781042611
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$34.99 |
| Rate for Payer: Aetna Commercial |
$33.05
|
| Rate for Payer: Aetna Medicare |
$10.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.15
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$9.72
|
| Rate for Payer: BCBS Trust/PPO |
$31.96
|
| Rate for Payer: BCN Commercial |
$31.96
|
| Rate for Payer: BCN Medicare Advantage |
$9.72
|
| 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: Health Alliance Plan Medicare Advantage |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$34.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.16
|
| Rate for Payer: Mclaren Medicaid |
$6.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.21
|
| Rate for Payer: Meridian Medicaid |
$7.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.69
|
| 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: PACE Senior Care Partners |
$9.23
|
| Rate for Payer: PACE SWMI |
$9.72
|
| Rate for Payer: PHP Commercial |
$33.05
|
| Rate for Payer: PHP Medicare Advantage |
$9.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$33.83
|
| Rate for Payer: Priority Health Medicare |
$9.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.06
|
| Rate for Payer: Railroad Medicare Medicare |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.21
|
| Rate for Payer: UHC Core |
$32.46
|
| Rate for Payer: UHC Exchange |
$9.72
|
| Rate for Payer: UHC Medicaid |
$6.85
|
| Rate for Payer: UHC Medicare Advantage |
$9.72
|
| Rate for Payer: UHCCP Medicaid |
$6.85
|
| Rate for Payer: VA VA |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.16
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$134.25
|
|
|
Service Code
|
NDC 50742055205
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.44 |
| Max. Negotiated Rate |
$120.83 |
| Rate for Payer: Aetna Commercial |
$114.11
|
| Rate for Payer: BCBS Trust/PPO |
$110.88
|
| Rate for Payer: BCN Commercial |
$110.88
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cofinity Commercial |
$115.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.40
|
| Rate for Payer: Healthscope Commercial |
$120.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.11
|
| Rate for Payer: Nomi Health Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.69
|
| Rate for Payer: PHP Commercial |
$114.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.14
|
| Rate for Payer: UHC Core |
$112.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.69
|
|
|
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
|
$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
|
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
|
$134.25
|
|
|
Service Code
|
NDC 50742055205
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$120.83 |
| Rate for Payer: Aetna Commercial |
$114.11
|
| Rate for Payer: Aetna Medicare |
$34.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.95
|
| Rate for Payer: BCBS Complete |
$24.85
|
| Rate for Payer: BCBS MAPPO |
$33.56
|
| Rate for Payer: BCBS Trust/PPO |
$110.37
|
| Rate for Payer: BCN Commercial |
$110.37
|
| Rate for Payer: BCN Medicare Advantage |
$33.56
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cofinity Commercial |
$115.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.56
|
| Rate for Payer: Healthscope Commercial |
$120.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.69
|
| Rate for Payer: Mclaren Medicaid |
$23.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.24
|
| Rate for Payer: Meridian Medicaid |
$24.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$36.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.11
|
| Rate for Payer: Nomi Health Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.69
|
| Rate for Payer: PACE Senior Care Partners |
$31.88
|
| Rate for Payer: PACE SWMI |
$33.56
|
| Rate for Payer: PHP Commercial |
$114.11
|
| Rate for Payer: PHP Medicare Advantage |
$33.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$116.80
|
| Rate for Payer: Priority Health Medicare |
$33.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.44
|
| Rate for Payer: Railroad Medicare Medicare |
$33.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.14
|
| Rate for Payer: UHC Core |
$112.10
|
| Rate for Payer: UHC Exchange |
$33.56
|
| Rate for Payer: UHC Medicaid |
$23.67
|
| Rate for Payer: UHC Medicare Advantage |
$33.56
|
| Rate for Payer: UHCCP Medicaid |
$23.67
|
| Rate for Payer: VA VA |
$33.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.69
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
OP
|
$20.98
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Commercial |
$36.32
|
| Rate for Payer: Aetna Medicare |
$14.18
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna Medicare |
$11.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.04
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: BCBS Complete |
$10.10
|
| Rate for Payer: BCBS MAPPO |
$13.63
|
| Rate for Payer: BCBS MAPPO |
$5.25
|
| Rate for Payer: BCBS MAPPO |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$35.13
|
| Rate for Payer: BCBS Trust/PPO |
$44.84
|
| Rate for Payer: BCN Commercial |
$35.13
|
| Rate for Payer: BCN Commercial |
$44.84
|
| Rate for Payer: BCN Commercial |
$17.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.63
|
| Rate for Payer: BCN Medicare Advantage |
$10.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.25
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.25
|
| Rate for Payer: Healthscope Commercial |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.05
|
| Rate for Payer: Mclaren Medicaid |
$3.70
|
| Rate for Payer: Mclaren Medicaid |
$9.62
|
| Rate for Payer: Mclaren Medicaid |
$7.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.32
|
| Rate for Payer: Meridian Medicaid |
$10.10
|
| Rate for Payer: Meridian Medicaid |
$3.88
|
| Rate for Payer: Meridian Medicaid |
$7.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.32
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: Nomi Health Commercial |
$35.04
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: PACE Senior Care Partners |
$10.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.98
|
| Rate for Payer: PACE Senior Care Partners |
$12.95
|
| Rate for Payer: PACE SWMI |
$13.63
|
| Rate for Payer: PACE SWMI |
$10.68
|
| Rate for Payer: PACE SWMI |
$5.25
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$36.32
|
| Rate for Payer: PHP Medicare Advantage |
$10.68
|
| Rate for Payer: PHP Medicare Advantage |
$5.25
|
| Rate for Payer: PHP Medicare Advantage |
$13.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: Priority Health Medicare |
$10.79
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.60
|
| Rate for Payer: Railroad Medicare Medicare |
$10.68
|
| Rate for Payer: Railroad Medicare Medicare |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$5.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.46
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Core |
$35.68
|
| Rate for Payer: UHC Exchange |
$13.63
|
| Rate for Payer: UHC Exchange |
$10.68
|
| Rate for Payer: UHC Exchange |
$5.25
|
| Rate for Payer: UHC Medicaid |
$3.70
|
| Rate for Payer: UHC Medicaid |
$9.62
|
| Rate for Payer: UHC Medicaid |
$7.53
|
| Rate for Payer: UHC Medicare Advantage |
$10.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$7.53
|
| Rate for Payer: UHCCP Medicaid |
$3.70
|
| Rate for Payer: UHCCP Medicaid |
$9.62
|
| Rate for Payer: VA VA |
$5.25
|
| Rate for Payer: VA VA |
$13.63
|
| Rate for Payer: VA VA |
$10.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.91
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$20.98
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$36.32
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: BCBS Trust/PPO |
$35.29
|
| Rate for Payer: BCBS Trust/PPO |
$17.33
|
| Rate for Payer: BCBS Trust/PPO |
$45.04
|
| Rate for Payer: BCN Commercial |
$35.29
|
| Rate for Payer: BCN Commercial |
$17.33
|
| Rate for Payer: BCN Commercial |
$45.04
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Healthscope Commercial |
$38.46
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$35.04
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.91
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$36.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.46
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Core |
$35.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.05
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.64
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Medicare |
$4.57
|
| Rate for Payer: Aetna Medicare |
$5.08
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Aetna Medicare |
$5.37
|
| Rate for Payer: Aetna Medicare |
$3.74
|
| Rate for Payer: Aetna Medicare |
$6.43
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.50
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: BCBS Complete |
$2.66
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS Complete |
$3.82
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: BCBS Complete |
$3.61
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$5.25
|
| Rate for Payer: BCBS MAPPO |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$6.18
|
| Rate for Payer: BCBS MAPPO |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$16.97
|
| Rate for Payer: BCBS Trust/PPO |
$11.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.44
|
| Rate for Payer: BCBS Trust/PPO |
$16.05
|
| Rate for Payer: BCN Commercial |
$14.44
|
| Rate for Payer: BCN Commercial |
$11.83
|
| Rate for Payer: BCN Commercial |
$8.10
|
| Rate for Payer: BCN Commercial |
$20.32
|
| Rate for Payer: BCN Commercial |
$17.25
|
| Rate for Payer: BCN Commercial |
$16.05
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.16
|
| Rate for Payer: BCN Medicare Advantage |
$4.39
|
| Rate for Payer: BCN Medicare Advantage |
$2.46
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: BCN Medicare Advantage |
$3.60
|
| Rate for Payer: BCN Medicare Advantage |
$6.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.25
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.25
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$17.57
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Mclaren Medicaid |
$4.36
|
| Rate for Payer: Mclaren Medicaid |
$3.10
|
| Rate for Payer: Mclaren Medicaid |
$2.54
|
| Rate for Payer: Mclaren Medicaid |
$3.64
|
| Rate for Payer: Mclaren Medicaid |
$3.70
|
| Rate for Payer: Mclaren Medicaid |
$1.74
|
| Rate for Payer: Mclaren Medicaid |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.42
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: Meridian Medicaid |
$2.66
|
| Rate for Payer: Meridian Medicaid |
$3.61
|
| Rate for Payer: Meridian Medicaid |
$3.82
|
| Rate for Payer: Meridian Medicaid |
$3.88
|
| Rate for Payer: Meridian Medicaid |
$4.58
|
| Rate for Payer: Meridian Medicaid |
$1.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Nomi Health Commercial |
$16.01
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$16.92
|
| Rate for Payer: Nomi Health Commercial |
$14.40
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$20.27
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.54
|
| Rate for Payer: PACE Senior Care Partners |
$4.98
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE Senior Care Partners |
$3.42
|
| Rate for Payer: PACE Senior Care Partners |
$5.87
|
| Rate for Payer: PACE Senior Care Partners |
$4.64
|
| Rate for Payer: PACE Senior Care Partners |
$2.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.90
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PACE SWMI |
$6.18
|
| Rate for Payer: PACE SWMI |
$5.25
|
| Rate for Payer: PACE SWMI |
$4.39
|
| Rate for Payer: PACE SWMI |
$5.16
|
| Rate for Payer: PACE SWMI |
$2.46
|
| Rate for Payer: PACE SWMI |
$3.60
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Medicare Advantage |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$5.25
|
| Rate for Payer: PHP Medicare Advantage |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: PHP Medicare Advantage |
$5.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$2.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.96
|
| Rate for Payer: Priority Health Medicare |
$6.24
|
| Rate for Payer: Priority Health Medicare |
$2.49
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$5.21
|
| Rate for Payer: Priority Health Medicare |
$3.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.22
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5.25
|
| Rate for Payer: Railroad Medicare Medicare |
$2.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.60
|
| Rate for Payer: Railroad Medicare Medicare |
$6.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.66
|
| Rate for Payer: UHC Core |
$17.23
|
| Rate for Payer: UHC Core |
$12.02
|
| Rate for Payer: UHC Core |
$16.30
|
| Rate for Payer: UHC Core |
$20.64
|
| Rate for Payer: UHC Core |
$8.22
|
| Rate for Payer: UHC Core |
$14.66
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Exchange |
$4.39
|
| Rate for Payer: UHC Exchange |
$5.25
|
| Rate for Payer: UHC Exchange |
$3.60
|
| Rate for Payer: UHC Exchange |
$6.18
|
| Rate for Payer: UHC Exchange |
$5.16
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Medicaid |
$1.74
|
| Rate for Payer: UHC Medicaid |
$4.36
|
| Rate for Payer: UHC Medicaid |
$3.44
|
| Rate for Payer: UHC Medicaid |
$2.54
|
| Rate for Payer: UHC Medicaid |
$3.10
|
| Rate for Payer: UHC Medicaid |
$3.70
|
| Rate for Payer: UHC Medicaid |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$4.39
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$3.60
|
| Rate for Payer: UHC Medicare Advantage |
$5.16
|
| Rate for Payer: UHC Medicare Advantage |
$6.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.25
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: UHCCP Medicaid |
$2.54
|
| Rate for Payer: UHCCP Medicaid |
$1.74
|
| Rate for Payer: UHCCP Medicaid |
$3.10
|
| Rate for Payer: UHCCP Medicaid |
$3.64
|
| Rate for Payer: UHCCP Medicaid |
$3.70
|
| Rate for Payer: UHCCP Medicaid |
$4.36
|
| Rate for Payer: UHCCP Medicaid |
$3.44
|
| Rate for Payer: VA VA |
$3.60
|
| Rate for Payer: VA VA |
$6.18
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: VA VA |
$5.25
|
| Rate for Payer: VA VA |
$2.46
|
| Rate for Payer: VA VA |
$4.39
|
| Rate for Payer: VA VA |
$5.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.48
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$9.85
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: BCBS Trust/PPO |
$8.14
|
| Rate for Payer: BCBS Trust/PPO |
$14.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.42
|
| Rate for Payer: BCBS Trust/PPO |
$11.88
|
| Rate for Payer: BCBS Trust/PPO |
$17.33
|
| Rate for Payer: BCBS Trust/PPO |
$16.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.05
|
| Rate for Payer: BCN Commercial |
$16.12
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: BCN Commercial |
$8.14
|
| Rate for Payer: BCN Commercial |
$17.33
|
| Rate for Payer: BCN Commercial |
$14.50
|
| Rate for Payer: BCN Commercial |
$17.05
|
| Rate for Payer: BCN Commercial |
$11.88
|
| Rate for Payer: Cash Price |
$15.62
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$17.57
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.59
|
| Rate for Payer: Nomi Health Commercial |
$16.92
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: Nomi Health Commercial |
$20.27
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$16.01
|
| Rate for Payer: Nomi Health Commercial |
$14.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.64
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$16.59
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.18
|
| Rate for Payer: UHC Core |
$12.02
|
| Rate for Payer: UHC Core |
$20.64
|
| Rate for Payer: UHC Core |
$14.66
|
| Rate for Payer: UHC Core |
$16.30
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Core |
$8.22
|
| Rate for Payer: UHC Core |
$17.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
OP
|
$73.79
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.01 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: Aetna Medicare |
$19.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.06
|
| Rate for Payer: BCBS Complete |
$13.66
|
| Rate for Payer: BCBS MAPPO |
$18.45
|
| Rate for Payer: BCBS Trust/PPO |
$60.66
|
| Rate for Payer: BCN Commercial |
$60.66
|
| Rate for Payer: BCN Medicare Advantage |
$18.45
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Mclaren Medicaid |
$13.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.37
|
| Rate for Payer: Meridian Medicaid |
$13.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: Nomi Health Commercial |
$60.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.34
|
| Rate for Payer: PACE Senior Care Partners |
$17.53
|
| Rate for Payer: PACE SWMI |
$18.45
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: PHP Medicare Advantage |
$18.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.20
|
| Rate for Payer: Priority Health Medicare |
$18.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.36
|
| Rate for Payer: Railroad Medicare Medicare |
$18.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.94
|
| Rate for Payer: UHC Core |
$61.61
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Medicaid |
$13.01
|
| Rate for Payer: UHC Medicare Advantage |
$18.45
|
| Rate for Payer: UHCCP Medicaid |
$13.01
|
| Rate for Payer: VA VA |
$18.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIXIR
|
Facility
|
IP
|
$73.79
|
|
|
Service Code
|
NDC 50383077816
|
| Hospital Charge Code |
179529
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: BCBS Trust/PPO |
$60.94
|
| Rate for Payer: BCN Commercial |
$60.94
|
| Rate for Payer: Cash Price |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.03
|
| Rate for Payer: Healthscope Commercial |
$66.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: Nomi Health Commercial |
$60.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.34
|
| Rate for Payer: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.94
|
| Rate for Payer: UHC Core |
$61.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.34
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
NDC 50268033611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.16
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$3.33
|
| Rate for Payer: BCBS Trust/PPO |
$10.95
|
| Rate for Payer: BCN Commercial |
$10.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.33
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.99
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.50
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PACE Senior Care Partners |
$3.16
|
| Rate for Payer: PACE SWMI |
$3.33
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: PHP Medicare Advantage |
$3.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.59
|
| Rate for Payer: Priority Health Medicare |
$3.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$11.12
|
| Rate for Payer: UHC Exchange |
$3.33
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHC Medicare Advantage |
$3.33
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: VA VA |
$3.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.99
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
NDC 50268033611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: BCBS Trust/PPO |
$11.00
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$11.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.99
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$13.32
|
|
|
Service Code
|
NDC 50268033624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: BCBS Trust/PPO |
$11.00
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$11.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.99
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$8.23
|
| Rate for Payer: BCN Commercial |
$8.23
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Nomi Health Commercial |
$8.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.76
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.96 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna Medicare |
$2.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.11
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$2.49
|
| Rate for Payer: BCBS Trust/PPO |
$8.19
|
| Rate for Payer: BCN Commercial |
$8.19
|
| Rate for Payer: BCN Medicare Advantage |
$2.49
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$8.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.47
|
| Rate for Payer: Mclaren Medicaid |
$1.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.61
|
| Rate for Payer: Meridian Medicaid |
$1.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.47
|
| Rate for Payer: Nomi Health Commercial |
$8.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.47
|
| Rate for Payer: PACE Senior Care Partners |
$2.37
|
| Rate for Payer: PACE SWMI |
$2.49
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: PHP Medicare Advantage |
$2.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.67
|
| Rate for Payer: Priority Health Medicare |
$2.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.76
|
| Rate for Payer: UHC Core |
$8.32
|
| Rate for Payer: UHC Exchange |
$2.49
|
| Rate for Payer: UHC Medicaid |
$1.76
|
| Rate for Payer: UHC Medicare Advantage |
$2.49
|
| Rate for Payer: UHCCP Medicaid |
$1.76
|
| Rate for Payer: VA VA |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.47
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$13.32
|
|
|
Service Code
|
NDC 50268033624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$11.99 |
| Rate for Payer: Aetna Commercial |
$11.32
|
| Rate for Payer: Aetna Medicare |
$3.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.16
|
| Rate for Payer: BCBS Complete |
$2.47
|
| Rate for Payer: BCBS MAPPO |
$3.33
|
| Rate for Payer: BCBS Trust/PPO |
$10.95
|
| Rate for Payer: BCN Commercial |
$10.95
|
| Rate for Payer: BCN Medicare Advantage |
$3.33
|
| Rate for Payer: Cash Price |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$11.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.33
|
| Rate for Payer: Healthscope Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.99
|
| Rate for Payer: Mclaren Medicaid |
$2.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.50
|
| Rate for Payer: Meridian Medicaid |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$10.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.99
|
| Rate for Payer: PACE Senior Care Partners |
$3.16
|
| Rate for Payer: PACE SWMI |
$3.33
|
| Rate for Payer: PHP Commercial |
$11.32
|
| Rate for Payer: PHP Medicare Advantage |
$3.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.59
|
| Rate for Payer: Priority Health Medicare |
$3.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.72
|
| Rate for Payer: UHC Core |
$11.12
|
| Rate for Payer: UHC Exchange |
$3.33
|
| Rate for Payer: UHC Medicaid |
$2.35
|
| Rate for Payer: UHC Medicare Advantage |
$3.33
|
| Rate for Payer: UHCCP Medicaid |
$2.35
|
| Rate for Payer: VA VA |
$3.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.99
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$17.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.30
|
| Rate for Payer: BCBS Complete |
$12.61
|
| Rate for Payer: BCBS MAPPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$56.03
|
| Rate for Payer: BCN Commercial |
$56.03
|
| Rate for Payer: BCN Medicare Advantage |
$17.04
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.04
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: Mclaren Medicaid |
$12.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.89
|
| Rate for Payer: Meridian Medicaid |
$12.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Nomi Health Commercial |
$55.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PACE Senior Care Partners |
$16.19
|
| Rate for Payer: PACE SWMI |
$17.04
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$17.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.29
|
| Rate for Payer: Priority Health Medicare |
$17.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.43
|
| Rate for Payer: Railroad Medicare Medicare |
$17.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.97
|
| Rate for Payer: UHC Core |
$56.91
|
| Rate for Payer: UHC Exchange |
$17.04
|
| Rate for Payer: UHC Medicaid |
$12.01
|
| Rate for Payer: UHC Medicare Advantage |
$17.04
|
| Rate for Payer: UHCCP Medicaid |
$12.01
|
| Rate for Payer: VA VA |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: BCBS Trust/PPO |
$56.29
|
| Rate for Payer: BCN Commercial |
$56.29
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: Nomi Health Commercial |
$55.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.11
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.97
|
| Rate for Payer: UHC Core |
$56.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$2,921.04
|
|
|
Service Code
|
APR-DRG 7222
|
| Min. Negotiated Rate |
$2,781.94 |
| Max. Negotiated Rate |
$2,921.04 |
| Rate for Payer: BCBS Complete |
$2,921.04
|
| Rate for Payer: Mclaren Medicaid |
$2,781.94
|
| Rate for Payer: Meridian Medicaid |
$2,921.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,781.94
|
| Rate for Payer: UHC Medicaid |
$2,781.94
|
| Rate for Payer: UHCCP Medicaid |
$2,781.94
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$2,416.23
|
|
|
Service Code
|
APR-DRG 7221
|
| Min. Negotiated Rate |
$2,301.18 |
| Max. Negotiated Rate |
$2,416.23 |
| Rate for Payer: BCBS Complete |
$2,416.23
|
| Rate for Payer: Mclaren Medicaid |
$2,301.18
|
| Rate for Payer: Meridian Medicaid |
$2,416.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,301.18
|
| Rate for Payer: UHC Medicaid |
$2,301.18
|
| Rate for Payer: UHCCP Medicaid |
$2,301.18
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$9,998.32
|
|
|
Service Code
|
APR-DRG 7224
|
| Min. Negotiated Rate |
$9,522.21 |
| Max. Negotiated Rate |
$9,998.32 |
| Rate for Payer: BCBS Complete |
$9,998.32
|
| Rate for Payer: Mclaren Medicaid |
$9,522.21
|
| Rate for Payer: Meridian Medicaid |
$9,998.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,522.21
|
| Rate for Payer: UHC Medicaid |
$9,522.21
|
| Rate for Payer: UHCCP Medicaid |
$9,522.21
|
|
