|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$215.73
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$194.16 |
| Rate for Payer: Aetna Commercial |
$183.37
|
| Rate for Payer: Aetna Medicare |
$56.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.42
|
| Rate for Payer: BCBS Complete |
$86.29
|
| Rate for Payer: BCBS MAPPO |
$53.93
|
| Rate for Payer: BCBS Trust/PPO |
$177.35
|
| Rate for Payer: BCN Commercial |
$167.73
|
| Rate for Payer: BCN Medicare Advantage |
$53.93
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$185.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.93
|
| Rate for Payer: Healthscope Commercial |
$194.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: PACE Senior Care Partners |
$51.24
|
| Rate for Payer: PACE SWMI |
$53.93
|
| Rate for Payer: PHP Commercial |
$183.37
|
| Rate for Payer: PHP Medicare Advantage |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO |
$187.69
|
| Rate for Payer: Priority Health Medicare |
$54.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.54
|
| Rate for Payer: Railroad Medicare Medicare |
$53.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.84
|
| Rate for Payer: UHC Core |
$180.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.93
|
| Rate for Payer: UHC Exchange |
$53.93
|
| Rate for Payer: UHC Medicare Advantage |
$53.93
|
| Rate for Payer: VA VA |
$53.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.80
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.14
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health HMO/PPO |
$3.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$3.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$121.68
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$109.51 |
| Rate for Payer: Aetna Commercial |
$103.43
|
| Rate for Payer: BCBS Trust/PPO |
$99.33
|
| Rate for Payer: BCN Commercial |
$94.03
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.34
|
| Rate for Payer: Healthscope Commercial |
$109.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.43
|
| Rate for Payer: Nomi Health Commercial |
$99.78
|
| Rate for Payer: PHP Commercial |
$103.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health HMO/PPO |
$105.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.08
|
| Rate for Payer: UHC Core |
$101.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.26
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$121.68
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$109.51 |
| Rate for Payer: Aetna Commercial |
$103.43
|
| Rate for Payer: Aetna Medicare |
$31.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.02
|
| Rate for Payer: BCBS Complete |
$48.67
|
| Rate for Payer: BCBS MAPPO |
$30.42
|
| Rate for Payer: BCBS Trust/PPO |
$100.03
|
| Rate for Payer: BCN Commercial |
$94.61
|
| Rate for Payer: BCN Medicare Advantage |
$30.42
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.42
|
| Rate for Payer: Healthscope Commercial |
$109.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.43
|
| Rate for Payer: Nomi Health Commercial |
$99.78
|
| Rate for Payer: PACE Senior Care Partners |
$28.90
|
| Rate for Payer: PACE SWMI |
$30.42
|
| Rate for Payer: PHP Commercial |
$103.43
|
| Rate for Payer: PHP Medicare Advantage |
$30.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health HMO/PPO |
$105.86
|
| Rate for Payer: Priority Health Medicare |
$30.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.53
|
| Rate for Payer: Railroad Medicare Medicare |
$30.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.08
|
| Rate for Payer: UHC Core |
$101.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.42
|
| Rate for Payer: UHC Exchange |
$30.42
|
| Rate for Payer: UHC Medicare Advantage |
$30.42
|
| Rate for Payer: VA VA |
$30.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.26
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.16
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: Nomi Health Commercial |
$3.33
|
| Rate for Payer: PACE Senior Care Partners |
$0.96
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health HMO/PPO |
$3.53
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$3.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.02
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$92.12
|
|
|
Service Code
|
NDC 60505701402
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.88 |
| Max. Negotiated Rate |
$82.91 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: BCBS Trust/PPO |
$75.20
|
| Rate for Payer: BCN Commercial |
$71.19
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.70
|
| Rate for Payer: Healthscope Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.30
|
| Rate for Payer: Nomi Health Commercial |
$75.54
|
| Rate for Payer: PHP Commercial |
$78.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.88
|
| Rate for Payer: Priority Health HMO/PPO |
$80.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.07
|
| Rate for Payer: UHC Core |
$76.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.09
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$297.70
|
|
|
Service Code
|
NDC 60505708402
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$267.93 |
| Rate for Payer: Aetna Commercial |
$253.04
|
| Rate for Payer: Aetna Medicare |
$77.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.03
|
| Rate for Payer: BCBS Complete |
$119.08
|
| Rate for Payer: BCBS MAPPO |
$74.42
|
| Rate for Payer: BCBS Trust/PPO |
$244.74
|
| Rate for Payer: BCN Commercial |
$231.46
|
| Rate for Payer: BCN Medicare Advantage |
$74.42
|
| Rate for Payer: Cash Price |
$238.16
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.42
|
| Rate for Payer: Healthscope Commercial |
$267.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.04
|
| Rate for Payer: Nomi Health Commercial |
$244.11
|
| Rate for Payer: PACE Senior Care Partners |
$70.70
|
| Rate for Payer: PACE SWMI |
$74.42
|
| Rate for Payer: PHP Commercial |
$253.04
|
| Rate for Payer: PHP Medicare Advantage |
$74.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.50
|
| Rate for Payer: Priority Health HMO/PPO |
$259.00
|
| Rate for Payer: Priority Health Medicare |
$75.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.46
|
| Rate for Payer: Railroad Medicare Medicare |
$74.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.98
|
| Rate for Payer: UHC Core |
$248.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.42
|
| Rate for Payer: UHC Exchange |
$74.42
|
| Rate for Payer: UHC Medicare Advantage |
$74.42
|
| Rate for Payer: VA VA |
$74.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.28
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$59.54
|
|
|
Service Code
|
NDC 60505708400
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$50.61
|
| Rate for Payer: Aetna Medicare |
$15.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.61
|
| Rate for Payer: BCBS Complete |
$23.82
|
| Rate for Payer: BCBS MAPPO |
$14.88
|
| Rate for Payer: BCBS Trust/PPO |
$48.95
|
| Rate for Payer: BCN Commercial |
$46.29
|
| Rate for Payer: BCN Medicare Advantage |
$14.88
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.88
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.61
|
| Rate for Payer: Nomi Health Commercial |
$48.82
|
| Rate for Payer: PACE Senior Care Partners |
$14.14
|
| Rate for Payer: PACE SWMI |
$14.88
|
| Rate for Payer: PHP Commercial |
$50.61
|
| Rate for Payer: PHP Medicare Advantage |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.70
|
| Rate for Payer: Priority Health HMO/PPO |
$51.80
|
| Rate for Payer: Priority Health Medicare |
$15.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.89
|
| Rate for Payer: Railroad Medicare Medicare |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.40
|
| Rate for Payer: UHC Core |
$49.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.88
|
| Rate for Payer: UHC Exchange |
$14.88
|
| Rate for Payer: UHC Medicare Advantage |
$14.88
|
| Rate for Payer: VA VA |
$14.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$59.54
|
|
|
Service Code
|
NDC 60505708400
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$50.61
|
| Rate for Payer: BCBS Trust/PPO |
$48.60
|
| Rate for Payer: BCN Commercial |
$46.01
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.61
|
| Rate for Payer: Nomi Health Commercial |
$48.82
|
| Rate for Payer: PHP Commercial |
$50.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.70
|
| Rate for Payer: Priority Health HMO/PPO |
$51.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.40
|
| Rate for Payer: UHC Core |
$49.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$92.12
|
|
|
Service Code
|
NDC 60505701402
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$82.91 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Medicare |
$23.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.79
|
| Rate for Payer: BCBS Complete |
$36.85
|
| Rate for Payer: BCBS MAPPO |
$23.03
|
| Rate for Payer: BCBS Trust/PPO |
$75.73
|
| Rate for Payer: BCN Commercial |
$71.62
|
| Rate for Payer: BCN Medicare Advantage |
$23.03
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.30
|
| Rate for Payer: Nomi Health Commercial |
$75.54
|
| Rate for Payer: PACE Senior Care Partners |
$21.88
|
| Rate for Payer: PACE SWMI |
$23.03
|
| Rate for Payer: PHP Commercial |
$78.30
|
| Rate for Payer: PHP Medicare Advantage |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.88
|
| Rate for Payer: Priority Health HMO/PPO |
$80.14
|
| Rate for Payer: Priority Health Medicare |
$23.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.72
|
| Rate for Payer: Railroad Medicare Medicare |
$23.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.07
|
| Rate for Payer: UHC Core |
$76.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.03
|
| Rate for Payer: UHC Exchange |
$23.03
|
| Rate for Payer: UHC Medicare Advantage |
$23.03
|
| Rate for Payer: VA VA |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.09
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 60505701400
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health HMO/PPO |
$16.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$15.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 60505701400
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.76
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS MAPPO |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$15.15
|
| Rate for Payer: BCN Commercial |
$14.33
|
| Rate for Payer: BCN Medicare Advantage |
$4.61
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.61
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.67
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: PACE Senior Care Partners |
$4.38
|
| Rate for Payer: PACE SWMI |
$4.61
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Medicare Advantage |
$4.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.98
|
| Rate for Payer: Priority Health HMO/PPO |
$16.03
|
| Rate for Payer: Priority Health Medicare |
$4.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$15.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.61
|
| Rate for Payer: UHC Exchange |
$4.61
|
| Rate for Payer: UHC Medicare Advantage |
$4.61
|
| Rate for Payer: VA VA |
$4.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$297.70
|
|
|
Service Code
|
NDC 60505708402
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$267.93 |
| Rate for Payer: Aetna Commercial |
$253.04
|
| Rate for Payer: BCBS Trust/PPO |
$243.01
|
| Rate for Payer: BCN Commercial |
$230.06
|
| Rate for Payer: Cash Price |
$238.16
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.16
|
| Rate for Payer: Healthscope Commercial |
$267.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.04
|
| Rate for Payer: Nomi Health Commercial |
$244.11
|
| Rate for Payer: PHP Commercial |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.50
|
| Rate for Payer: Priority Health HMO/PPO |
$259.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.98
|
| Rate for Payer: UHC Core |
$248.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.28
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$52.44
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: BCBS Trust/PPO |
$42.81
|
| Rate for Payer: BCN Commercial |
$40.53
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$45.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| Rate for Payer: PHP Commercial |
$44.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health HMO/PPO |
$45.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.15
|
| Rate for Payer: UHC Core |
$43.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.33
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$262.19
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$235.97 |
| Rate for Payer: Aetna Commercial |
$222.86
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.93
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: BCBS MAPPO |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$215.55
|
| Rate for Payer: BCN Commercial |
$203.85
|
| Rate for Payer: BCN Medicare Advantage |
$65.55
|
| Rate for Payer: Cash Price |
$209.75
|
| Rate for Payer: Cofinity Commercial |
$225.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$235.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.86
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: PACE Senior Care Partners |
$62.27
|
| Rate for Payer: PACE SWMI |
$65.55
|
| Rate for Payer: PHP Commercial |
$222.86
|
| Rate for Payer: PHP Medicare Advantage |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.42
|
| Rate for Payer: Priority Health HMO/PPO |
$228.11
|
| Rate for Payer: Priority Health Medicare |
$66.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.67
|
| Rate for Payer: Railroad Medicare Medicare |
$65.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.73
|
| Rate for Payer: UHC Core |
$218.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.55
|
| Rate for Payer: UHC Exchange |
$65.55
|
| Rate for Payer: UHC Medicare Advantage |
$65.55
|
| Rate for Payer: VA VA |
$65.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.64
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$52.44
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.39
|
| Rate for Payer: BCBS Complete |
$20.98
|
| Rate for Payer: BCBS MAPPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$43.11
|
| Rate for Payer: BCN Commercial |
$40.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.11
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$45.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| Rate for Payer: PACE Senior Care Partners |
$12.45
|
| Rate for Payer: PACE SWMI |
$13.11
|
| Rate for Payer: PHP Commercial |
$44.57
|
| Rate for Payer: PHP Medicare Advantage |
$13.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health HMO/PPO |
$45.62
|
| Rate for Payer: Priority Health Medicare |
$13.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.13
|
| Rate for Payer: Railroad Medicare Medicare |
$13.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.15
|
| Rate for Payer: UHC Core |
$43.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.11
|
| Rate for Payer: UHC Exchange |
$13.11
|
| Rate for Payer: UHC Medicare Advantage |
$13.11
|
| Rate for Payer: VA VA |
$13.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.33
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.19
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.42 |
| Max. Negotiated Rate |
$235.97 |
| Rate for Payer: Aetna Commercial |
$222.86
|
| Rate for Payer: BCBS Trust/PPO |
$214.03
|
| Rate for Payer: BCN Commercial |
$202.62
|
| Rate for Payer: Cash Price |
$209.75
|
| Rate for Payer: Cofinity Commercial |
$225.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.75
|
| Rate for Payer: Healthscope Commercial |
$235.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.86
|
| Rate for Payer: Nomi Health Commercial |
$215.00
|
| Rate for Payer: PHP Commercial |
$222.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.42
|
| Rate for Payer: Priority Health HMO/PPO |
$228.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.73
|
| Rate for Payer: UHC Core |
$218.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.64
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$16.57
|
|
|
Service Code
|
NDC 60505708100
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: Aetna Medicare |
$4.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.18
|
| Rate for Payer: BCBS Complete |
$6.63
|
| Rate for Payer: BCBS MAPPO |
$4.14
|
| Rate for Payer: BCBS Trust/PPO |
$13.62
|
| Rate for Payer: BCN Commercial |
$12.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.14
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cofinity Commercial |
$14.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Nomi Health Commercial |
$13.59
|
| Rate for Payer: PACE Senior Care Partners |
$3.94
|
| Rate for Payer: PACE SWMI |
$4.14
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: PHP Medicare Advantage |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.77
|
| Rate for Payer: Priority Health HMO/PPO |
$14.42
|
| Rate for Payer: Priority Health Medicare |
$4.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.14
|
| Rate for Payer: UHC Exchange |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$4.14
|
| Rate for Payer: VA VA |
$4.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.43
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$110.52
|
|
|
Service Code
|
NDC 00406912576
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$99.47 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: Aetna Medicare |
$28.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.54
|
| Rate for Payer: BCBS Complete |
$44.21
|
| Rate for Payer: BCBS MAPPO |
$27.63
|
| Rate for Payer: BCBS Trust/PPO |
$90.86
|
| Rate for Payer: BCN Commercial |
$85.93
|
| Rate for Payer: BCN Medicare Advantage |
$27.63
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.63
|
| Rate for Payer: Healthscope Commercial |
$99.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: PACE Senior Care Partners |
$26.25
|
| Rate for Payer: PACE SWMI |
$27.63
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: PHP Medicare Advantage |
$27.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health HMO/PPO |
$96.15
|
| Rate for Payer: Priority Health Medicare |
$27.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.05
|
| Rate for Payer: Railroad Medicare Medicare |
$27.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.26
|
| Rate for Payer: UHC Core |
$92.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.63
|
| Rate for Payer: UHC Exchange |
$27.63
|
| Rate for Payer: UHC Medicare Advantage |
$27.63
|
| Rate for Payer: VA VA |
$27.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.89
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$16.57
|
|
|
Service Code
|
NDC 60505708100
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cofinity Commercial |
$14.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.08
|
| Rate for Payer: Nomi Health Commercial |
$13.59
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.77
|
| Rate for Payer: Priority Health HMO/PPO |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.43
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$110.52
|
|
|
Service Code
|
NDC 00406912576
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.84 |
| Max. Negotiated Rate |
$99.47 |
| Rate for Payer: Aetna Commercial |
$93.94
|
| Rate for Payer: BCBS Trust/PPO |
$90.22
|
| Rate for Payer: BCN Commercial |
$85.41
|
| Rate for Payer: Cash Price |
$88.42
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.42
|
| Rate for Payer: Healthscope Commercial |
$99.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$90.63
|
| Rate for Payer: PHP Commercial |
$93.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.84
|
| Rate for Payer: Priority Health HMO/PPO |
$96.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.26
|
| Rate for Payer: UHC Core |
$92.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.89
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$82.84
|
|
|
Service Code
|
NDC 60505708102
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.67 |
| Max. Negotiated Rate |
$74.56 |
| Rate for Payer: Aetna Commercial |
$70.41
|
| Rate for Payer: Aetna Medicare |
$21.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.89
|
| Rate for Payer: BCBS Complete |
$33.14
|
| Rate for Payer: BCBS MAPPO |
$20.71
|
| Rate for Payer: BCBS Trust/PPO |
$68.10
|
| Rate for Payer: BCN Commercial |
$64.41
|
| Rate for Payer: BCN Medicare Advantage |
$20.71
|
| Rate for Payer: Cash Price |
$66.27
|
| Rate for Payer: Cofinity Commercial |
$71.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$74.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.41
|
| Rate for Payer: Nomi Health Commercial |
$67.93
|
| Rate for Payer: PACE Senior Care Partners |
$19.67
|
| Rate for Payer: PACE SWMI |
$20.71
|
| Rate for Payer: PHP Commercial |
$70.41
|
| Rate for Payer: PHP Medicare Advantage |
$20.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.85
|
| Rate for Payer: Priority Health HMO/PPO |
$72.07
|
| Rate for Payer: Priority Health Medicare |
$20.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.90
|
| Rate for Payer: UHC Core |
$69.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.71
|
| Rate for Payer: UHC Exchange |
$20.71
|
| Rate for Payer: UHC Medicare Advantage |
$20.71
|
| Rate for Payer: VA VA |
$20.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.13
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$82.84
|
|
|
Service Code
|
NDC 60505708102
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.85 |
| Max. Negotiated Rate |
$74.56 |
| Rate for Payer: Aetna Commercial |
$70.41
|
| Rate for Payer: BCBS Trust/PPO |
$67.62
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: Cash Price |
$66.27
|
| Rate for Payer: Cofinity Commercial |
$71.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.27
|
| Rate for Payer: Healthscope Commercial |
$74.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.41
|
| Rate for Payer: Nomi Health Commercial |
$67.93
|
| Rate for Payer: PHP Commercial |
$70.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.85
|
| Rate for Payer: Priority Health HMO/PPO |
$72.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.90
|
| Rate for Payer: UHC Core |
$69.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.13
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$30.08
|
|
|
Service Code
|
NDC 60505708200
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.40
|
| Rate for Payer: BCBS Complete |
$12.03
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$24.73
|
| Rate for Payer: BCN Commercial |
$23.39
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cofinity Commercial |
$25.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$27.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.57
|
| Rate for Payer: Nomi Health Commercial |
$24.67
|
| Rate for Payer: PACE Senior Care Partners |
$7.14
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Commercial |
$25.57
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.55
|
| Rate for Payer: Priority Health HMO/PPO |
$26.17
|
| Rate for Payer: Priority Health Medicare |
$7.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.15
|
| Rate for Payer: Railroad Medicare Medicare |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.47
|
| Rate for Payer: UHC Core |
$25.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.52
|
| Rate for Payer: UHC Exchange |
$7.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.52
|
| Rate for Payer: VA VA |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.56
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
NDC 60505708202
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: BCBS Trust/PPO |
$122.76
|
| Rate for Payer: BCN Commercial |
$116.22
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$123.32
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.75
|
| Rate for Payer: Priority Health HMO/PPO |
$130.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.34
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.79
|
|
