|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$204.87
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Aetna Commercial |
$174.14
|
| Rate for Payer: Aetna Medicare |
$53.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.02
|
| Rate for Payer: BCBS Complete |
$81.95
|
| Rate for Payer: BCBS MAPPO |
$51.22
|
| Rate for Payer: BCBS Trust/PPO |
$168.42
|
| Rate for Payer: BCN Commercial |
$159.29
|
| Rate for Payer: BCN Medicare Advantage |
$51.22
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cofinity Commercial |
$176.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.22
|
| Rate for Payer: Healthscope Commercial |
$184.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.14
|
| Rate for Payer: Nomi Health Commercial |
$167.99
|
| Rate for Payer: PACE Senior Care Partners |
$48.66
|
| Rate for Payer: PACE SWMI |
$51.22
|
| Rate for Payer: PHP Commercial |
$174.14
|
| Rate for Payer: PHP Medicare Advantage |
$51.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health HMO/PPO |
$178.24
|
| Rate for Payer: Priority Health Medicare |
$51.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.26
|
| Rate for Payer: Railroad Medicare Medicare |
$51.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.29
|
| Rate for Payer: UHC Core |
$171.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.22
|
| Rate for Payer: UHC Exchange |
$51.22
|
| Rate for Payer: UHC Medicare Advantage |
$51.22
|
| Rate for Payer: VA VA |
$51.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.65
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$40.98
|
|
|
Service Code
|
NDC 47781042611
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna Commercial |
$34.83
|
| Rate for Payer: Aetna Medicare |
$10.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.81
|
| Rate for Payer: BCBS Complete |
$16.39
|
| Rate for Payer: BCBS MAPPO |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$33.69
|
| Rate for Payer: BCN Commercial |
$31.86
|
| Rate for Payer: BCN Medicare Advantage |
$10.24
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.24
|
| Rate for Payer: Healthscope Commercial |
$36.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.83
|
| Rate for Payer: Nomi Health Commercial |
$33.60
|
| Rate for Payer: PACE Senior Care Partners |
$9.73
|
| Rate for Payer: PACE SWMI |
$10.24
|
| Rate for Payer: PHP Commercial |
$34.83
|
| Rate for Payer: PHP Medicare Advantage |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.64
|
| Rate for Payer: Priority Health HMO/PPO |
$35.65
|
| Rate for Payer: Priority Health Medicare |
$10.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.46
|
| Rate for Payer: Railroad Medicare Medicare |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.06
|
| Rate for Payer: UHC Core |
$34.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.24
|
| Rate for Payer: UHC Exchange |
$10.24
|
| Rate for Payer: UHC Medicare Advantage |
$10.24
|
| Rate for Payer: VA VA |
$10.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
|
|
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 |
$125.87 |
| Max. Negotiated Rate |
$174.28 |
| Rate for Payer: Aetna Commercial |
$164.60
|
| Rate for Payer: BCBS Trust/PPO |
$158.08
|
| Rate for Payer: BCN Commercial |
$149.65
|
| 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: PHP Commercial |
$164.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.87
|
| Rate for Payer: Priority Health HMO/PPO |
$168.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.75
|
| 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
|
$30.08
|
|
|
Service Code
|
NDC 60505708200
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$24.55
|
| Rate for Payer: BCN Commercial |
$23.25
|
| 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: Healthscope Commercial |
$27.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.57
|
| Rate for Payer: Nomi Health Commercial |
$24.67
|
| Rate for Payer: PHP Commercial |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.55
|
| Rate for Payer: Priority Health HMO/PPO |
$26.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.47
|
| Rate for Payer: UHC Core |
$25.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.56
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$40.98
|
|
|
Service Code
|
NDC 47781042611
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna Commercial |
$34.83
|
| Rate for Payer: BCBS Trust/PPO |
$33.45
|
| Rate for Payer: BCN Commercial |
$31.67
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$36.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.83
|
| Rate for Payer: Nomi Health Commercial |
$33.60
|
| Rate for Payer: PHP Commercial |
$34.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.64
|
| Rate for Payer: Priority Health HMO/PPO |
$35.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.06
|
| Rate for Payer: UHC Core |
$34.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$198.53
|
|
|
Service Code
|
NDC 00378912298
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$178.68 |
| Rate for Payer: Aetna Commercial |
$168.75
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.04
|
| Rate for Payer: BCBS Complete |
$79.41
|
| Rate for Payer: BCBS MAPPO |
$49.63
|
| Rate for Payer: BCBS Trust/PPO |
$163.21
|
| Rate for Payer: BCN Commercial |
$154.36
|
| Rate for Payer: BCN Medicare Advantage |
$49.63
|
| Rate for Payer: Cash Price |
$158.82
|
| Rate for Payer: Cofinity Commercial |
$170.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.63
|
| Rate for Payer: Healthscope Commercial |
$178.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.75
|
| Rate for Payer: Nomi Health Commercial |
$162.79
|
| Rate for Payer: PACE Senior Care Partners |
$47.15
|
| Rate for Payer: PACE SWMI |
$49.63
|
| Rate for Payer: PHP Commercial |
$168.75
|
| Rate for Payer: PHP Medicare Advantage |
$49.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.04
|
| Rate for Payer: Priority Health HMO/PPO |
$172.72
|
| Rate for Payer: Priority Health Medicare |
$50.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.02
|
| Rate for Payer: Railroad Medicare Medicare |
$49.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.71
|
| Rate for Payer: UHC Core |
$165.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.63
|
| Rate for Payer: UHC Exchange |
$49.63
|
| Rate for Payer: UHC Medicare Advantage |
$49.63
|
| Rate for Payer: VA VA |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.90
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$193.65
|
|
|
Service Code
|
NDC 00406905076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$174.28 |
| Rate for Payer: Aetna Commercial |
$164.60
|
| Rate for Payer: Aetna Medicare |
$50.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.52
|
| Rate for Payer: BCBS Complete |
$77.46
|
| Rate for Payer: BCBS MAPPO |
$48.41
|
| Rate for Payer: BCBS Trust/PPO |
$159.20
|
| Rate for Payer: BCN Commercial |
$150.56
|
| Rate for Payer: BCN Medicare Advantage |
$48.41
|
| Rate for Payer: Cash Price |
$154.92
|
| Rate for Payer: Cofinity Commercial |
$166.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.41
|
| Rate for Payer: Healthscope Commercial |
$174.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.60
|
| Rate for Payer: Nomi Health Commercial |
$158.79
|
| Rate for Payer: PACE Senior Care Partners |
$45.99
|
| Rate for Payer: PACE SWMI |
$48.41
|
| Rate for Payer: PHP Commercial |
$164.60
|
| Rate for Payer: PHP Medicare Advantage |
$48.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.87
|
| Rate for Payer: Priority Health HMO/PPO |
$168.48
|
| Rate for Payer: Priority Health Medicare |
$48.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.75
|
| Rate for Payer: Railroad Medicare Medicare |
$48.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.41
|
| Rate for Payer: UHC Core |
$161.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.41
|
| Rate for Payer: UHC Exchange |
$48.41
|
| Rate for Payer: UHC Medicare Advantage |
$48.41
|
| Rate for Payer: VA VA |
$48.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.24
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$198.53
|
|
|
Service Code
|
NDC 00378912298
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.04 |
| Max. Negotiated Rate |
$178.68 |
| Rate for Payer: Aetna Commercial |
$168.75
|
| Rate for Payer: BCBS Trust/PPO |
$162.06
|
| Rate for Payer: BCN Commercial |
$153.42
|
| Rate for Payer: Cash Price |
$158.82
|
| Rate for Payer: Cofinity Commercial |
$170.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.82
|
| Rate for Payer: Healthscope Commercial |
$178.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.75
|
| Rate for Payer: Nomi Health Commercial |
$162.79
|
| Rate for Payer: PHP Commercial |
$168.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.04
|
| Rate for Payer: Priority Health HMO/PPO |
$172.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.71
|
| Rate for Payer: UHC Core |
$165.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.90
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$39.71
|
|
|
Service Code
|
NDC 00378912216
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Aetna Commercial |
$33.75
|
| Rate for Payer: Aetna Medicare |
$10.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.41
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$32.65
|
| Rate for Payer: BCN Commercial |
$30.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.93
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cofinity Commercial |
$34.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.93
|
| Rate for Payer: Healthscope Commercial |
$35.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.75
|
| Rate for Payer: Nomi Health Commercial |
$32.56
|
| Rate for Payer: PACE Senior Care Partners |
$9.43
|
| Rate for Payer: PACE SWMI |
$9.93
|
| Rate for Payer: PHP Commercial |
$33.75
|
| Rate for Payer: PHP Medicare Advantage |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.81
|
| Rate for Payer: Priority Health HMO/PPO |
$34.55
|
| Rate for Payer: Priority Health Medicare |
$10.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.61
|
| Rate for Payer: Railroad Medicare Medicare |
$9.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Core |
$33.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.93
|
| Rate for Payer: UHC Exchange |
$9.93
|
| Rate for Payer: UHC Medicare Advantage |
$9.93
|
| Rate for Payer: VA VA |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.78
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
NDC 00378912216
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.81 |
| Max. Negotiated Rate |
$35.74 |
| Rate for Payer: Aetna Commercial |
$33.75
|
| Rate for Payer: BCBS Trust/PPO |
$32.42
|
| Rate for Payer: BCN Commercial |
$30.69
|
| Rate for Payer: Cash Price |
$31.77
|
| Rate for Payer: Cofinity Commercial |
$34.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Healthscope Commercial |
$35.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.75
|
| Rate for Payer: Nomi Health Commercial |
$32.56
|
| Rate for Payer: PHP Commercial |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.81
|
| Rate for Payer: Priority Health HMO/PPO |
$34.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Core |
$33.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.78
|
|
|
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
|
$204.87
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.17 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Aetna Commercial |
$174.14
|
| Rate for Payer: BCBS Trust/PPO |
$167.24
|
| Rate for Payer: BCN Commercial |
$158.32
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cofinity Commercial |
$176.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.90
|
| Rate for Payer: Healthscope Commercial |
$184.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.14
|
| Rate for Payer: Nomi Health Commercial |
$167.99
|
| Rate for Payer: PHP Commercial |
$174.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health HMO/PPO |
$178.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.29
|
| Rate for Payer: UHC Core |
$171.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.65
|
|
|
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 |
$13.64 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCBS Trust/PPO |
$34.38
|
| Rate for Payer: BCN Commercial |
$22.02
|
| Rate for Payer: BCN Commercial |
$16.21
|
| Rate for Payer: BCN Commercial |
$32.55
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$36.22
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$37.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.80
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$34.54
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$35.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health HMO/PPO |
$36.64
|
| Rate for Payer: Priority Health HMO/PPO |
$24.79
|
| Rate for Payer: Priority Health HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.46
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Core |
$35.17
|
| Rate for Payer: UHC Core |
$23.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
|
|
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 |
$4.98 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$35.80
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Medicare |
$10.95
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.16
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$16.85
|
| Rate for Payer: BCBS MAPPO |
$10.53
|
| Rate for Payer: BCBS MAPPO |
$5.24
|
| Rate for Payer: BCBS MAPPO |
$7.12
|
| Rate for Payer: BCBS Trust/PPO |
$23.42
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCBS Trust/PPO |
$34.63
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: BCN Commercial |
$32.75
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: BCN Medicare Advantage |
$5.24
|
| Rate for Payer: BCN Medicare Advantage |
$7.12
|
| Rate for Payer: BCN Medicare Advantage |
$10.53
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$33.70
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$36.22
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.24
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$37.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| 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 |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Nomi Health Commercial |
$34.54
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: PACE Senior Care Partners |
$10.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.98
|
| Rate for Payer: PACE Senior Care Partners |
$6.77
|
| Rate for Payer: PACE SWMI |
$7.12
|
| Rate for Payer: PACE SWMI |
$5.24
|
| Rate for Payer: PACE SWMI |
$10.53
|
| Rate for Payer: PHP Commercial |
$35.80
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Medicare Advantage |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$10.53
|
| Rate for Payer: PHP Medicare Advantage |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health HMO/PPO |
$36.64
|
| Rate for Payer: Priority Health HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health HMO/PPO |
$24.79
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health Medicare |
$10.64
|
| Rate for Payer: Priority Health Medicare |
$7.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: Railroad Medicare Medicare |
$7.12
|
| Rate for Payer: Railroad Medicare Medicare |
$10.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.46
|
| Rate for Payer: UHC Core |
$35.17
|
| Rate for Payer: UHC Core |
$23.79
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.12
|
| Rate for Payer: UHC Exchange |
$7.12
|
| Rate for Payer: UHC Exchange |
$5.24
|
| Rate for Payer: UHC Exchange |
$10.53
|
| Rate for Payer: UHC Medicare Advantage |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.12
|
| Rate for Payer: UHC Medicare Advantage |
$10.53
|
| Rate for Payer: VA VA |
$7.12
|
| Rate for Payer: VA VA |
$10.53
|
| Rate for Payer: VA VA |
$5.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
|
|
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 |
$6.40 |
| Max. Negotiated Rate |
$8.86 |
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: BCBS Trust/PPO |
$8.04
|
| Rate for Payer: BCBS Trust/PPO |
$14.33
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCBS Trust/PPO |
$11.75
|
| Rate for Payer: BCBS Trust/PPO |
$20.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.71
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCN Commercial |
$14.87
|
| Rate for Payer: BCN Commercial |
$22.02
|
| Rate for Payer: BCN Commercial |
$7.61
|
| Rate for Payer: BCN Commercial |
$19.10
|
| Rate for Payer: BCN Commercial |
$13.57
|
| Rate for Payer: BCN Commercial |
$16.21
|
| Rate for Payer: BCN Commercial |
$11.12
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| 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 |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$20.27
|
| Rate for Payer: Nomi Health Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health HMO/PPO |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$21.51
|
| Rate for Payer: Priority Health HMO/PPO |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health HMO/PPO |
$12.52
|
| Rate for Payer: Priority Health HMO/PPO |
$24.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.75
|
| 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) |
$15.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| Rate for Payer: UHC Core |
$12.02
|
| Rate for Payer: UHC Core |
$23.79
|
| Rate for Payer: UHC Core |
$14.66
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: UHC Core |
$20.64
|
| Rate for Payer: UHC Core |
$8.22
|
| Rate for Payer: UHC Core |
$17.52
|
| 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 |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.72
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$22.25 |
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: Aetna Commercial |
$8.37
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Medicare |
$4.57
|
| Rate for Payer: Aetna Medicare |
$3.74
|
| Rate for Payer: Aetna Medicare |
$6.43
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.56
|
| 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 |
$8.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.72
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$9.89
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS Complete |
$3.94
|
| Rate for Payer: BCBS MAPPO |
$6.18
|
| Rate for Payer: BCBS MAPPO |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$7.12
|
| Rate for Payer: BCBS MAPPO |
$5.24
|
| Rate for Payer: BCBS MAPPO |
$4.39
|
| Rate for Payer: BCBS MAPPO |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$4.81
|
| Rate for Payer: BCBS Trust/PPO |
$11.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.44
|
| Rate for Payer: BCBS Trust/PPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.42
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCBS Trust/PPO |
$20.32
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCN Commercial |
$16.31
|
| Rate for Payer: BCN Commercial |
$11.19
|
| Rate for Payer: BCN Commercial |
$14.96
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: BCN Commercial |
$22.15
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: BCN Medicare Advantage |
$2.46
|
| Rate for Payer: BCN Medicare Advantage |
$6.18
|
| Rate for Payer: BCN Medicare Advantage |
$7.12
|
| Rate for Payer: BCN Medicare Advantage |
$4.81
|
| Rate for Payer: BCN Medicare Advantage |
$3.60
|
| Rate for Payer: BCN Medicare Advantage |
$4.39
|
| Rate for Payer: BCN Medicare Advantage |
$5.24
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$7.88
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.24
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$22.25
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| 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 |
$4.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.05
|
| 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 |
$6.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Nomi Health Commercial |
$23.36
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$14.40
|
| Rate for Payer: Nomi Health Commercial |
$8.08
|
| Rate for Payer: Nomi Health Commercial |
$17.20
|
| Rate for Payer: Nomi Health Commercial |
$15.78
|
| Rate for Payer: Nomi Health Commercial |
$20.27
|
| Rate for Payer: PACE Senior Care Partners |
$5.87
|
| Rate for Payer: PACE Senior Care Partners |
$2.34
|
| 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 |
$4.57
|
| Rate for Payer: PACE Senior Care Partners |
$6.77
|
| Rate for Payer: PACE SWMI |
$7.12
|
| Rate for Payer: PACE SWMI |
$4.81
|
| Rate for Payer: PACE SWMI |
$6.18
|
| Rate for Payer: PACE SWMI |
$3.60
|
| Rate for Payer: PACE SWMI |
$5.24
|
| Rate for Payer: PACE SWMI |
$4.39
|
| Rate for Payer: PACE SWMI |
$2.46
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Medicare Advantage |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$5.24
|
| Rate for Payer: PHP Medicare Advantage |
$4.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.18
|
| Rate for Payer: PHP Medicare Advantage |
$7.12
|
| Rate for Payer: PHP Medicare Advantage |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health HMO/PPO |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$18.25
|
| Rate for Payer: Priority Health HMO/PPO |
$21.51
|
| Rate for Payer: Priority Health HMO/PPO |
$24.79
|
| Rate for Payer: Priority Health HMO/PPO |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$8.57
|
| Rate for Payer: Priority Health HMO/PPO |
$12.52
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health Medicare |
$4.86
|
| Rate for Payer: Priority Health Medicare |
$3.63
|
| Rate for Payer: Priority Health Medicare |
$6.24
|
| Rate for Payer: Priority Health Medicare |
$7.19
|
| Rate for Payer: Priority Health Medicare |
$2.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.60
|
| Rate for Payer: Railroad Medicare Medicare |
$7.12
|
| Rate for Payer: Railroad Medicare Medicare |
$5.24
|
| Rate for Payer: Railroad Medicare Medicare |
$4.81
|
| Rate for Payer: Railroad Medicare Medicare |
$4.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.93
|
| 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) |
$21.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.66
|
| Rate for Payer: UHC Core |
$14.66
|
| Rate for Payer: UHC Core |
$23.79
|
| Rate for Payer: UHC Core |
$12.02
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Core |
$16.07
|
| Rate for Payer: UHC Core |
$20.64
|
| Rate for Payer: UHC Core |
$8.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.46
|
| Rate for Payer: UHC Exchange |
$5.24
|
| Rate for Payer: UHC Exchange |
$7.12
|
| Rate for Payer: UHC Exchange |
$2.46
|
| Rate for Payer: UHC Exchange |
$4.39
|
| Rate for Payer: UHC Exchange |
$4.81
|
| Rate for Payer: UHC Exchange |
$3.60
|
| Rate for Payer: UHC Exchange |
$6.18
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$3.60
|
| Rate for Payer: UHC Medicare Advantage |
$4.81
|
| Rate for Payer: UHC Medicare Advantage |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.18
|
| Rate for Payer: UHC Medicare Advantage |
$7.12
|
| Rate for Payer: UHC Medicare Advantage |
$4.39
|
| Rate for Payer: VA VA |
$4.81
|
| Rate for Payer: VA VA |
$5.24
|
| Rate for Payer: VA VA |
$4.39
|
| Rate for Payer: VA VA |
$2.46
|
| Rate for Payer: VA VA |
$3.60
|
| Rate for Payer: VA VA |
$6.18
|
| Rate for Payer: VA VA |
$7.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
| 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 |
$17.53 |
| 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 |
$29.52
|
| Rate for Payer: BCBS MAPPO |
$18.45
|
| Rate for Payer: BCBS Trust/PPO |
$60.66
|
| Rate for Payer: BCN Commercial |
$57.37
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.72
|
| Rate for Payer: Nomi Health Commercial |
$60.51
|
| 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 Cigna Priority Health |
$47.96
|
| Rate for Payer: Priority Health HMO/PPO |
$64.20
|
| Rate for Payer: Priority Health Medicare |
$18.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.44
|
| 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 Dual Complete DSNP |
$18.45
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Medicare Advantage |
$18.45
|
| 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 |
$47.96 |
| Max. Negotiated Rate |
$66.41 |
| Rate for Payer: Aetna Commercial |
$62.72
|
| Rate for Payer: BCBS Trust/PPO |
$60.23
|
| Rate for Payer: BCN Commercial |
$57.02
|
| 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: PHP Commercial |
$62.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.96
|
| Rate for Payer: Priority Health HMO/PPO |
$64.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.44
|
| 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
|
$10.62
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.32
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| Rate for Payer: BCN Commercial |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Nomi Health Commercial |
$8.71
|
| Rate for Payer: PACE Senior Care Partners |
$2.52
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.90
|
| Rate for Payer: Priority Health HMO/PPO |
$9.24
|
| Rate for Payer: Priority Health Medicare |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.35
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.66
|
| Rate for Payer: UHC Exchange |
$2.66
|
| Rate for Payer: UHC Medicare Advantage |
$2.66
|
| Rate for Payer: VA VA |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$10.62
|
|
|
Service Code
|
NDC 00121053005
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna Commercial |
$9.03
|
| Rate for Payer: BCBS Trust/PPO |
$8.67
|
| Rate for Payer: BCN Commercial |
$8.21
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$9.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.03
|
| Rate for Payer: Nomi Health Commercial |
$8.71
|
| Rate for Payer: PHP Commercial |
$9.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.90
|
| Rate for Payer: Priority Health HMO/PPO |
$9.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.35
|
| Rate for Payer: UHC Core |
$8.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.96
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 50268033624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
NDC 50268033611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$9.31
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
NDC 50268033611
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Medicare |
$3.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.77
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS MAPPO |
$3.01
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.01
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PACE Senior Care Partners |
$2.86
|
| Rate for Payer: PACE SWMI |
$3.01
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Medicare |
$3.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.01
|
| Rate for Payer: UHC Exchange |
$3.01
|
| Rate for Payer: UHC Medicare Advantage |
$3.01
|
| Rate for Payer: VA VA |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FERROUS SULFATE 300 MG (60 MG IRON)/5 ML ORAL LIQUID
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
NDC 50268033624
|
| Hospital Charge Code |
3071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Medicare |
$3.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.77
|
| Rate for Payer: BCBS Complete |
$4.82
|
| Rate for Payer: BCBS MAPPO |
$3.01
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.01
|
| Rate for Payer: Cash Price |
$9.64
|
| Rate for Payer: Cofinity Commercial |
$10.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.24
|
| Rate for Payer: Nomi Health Commercial |
$9.88
|
| Rate for Payer: PACE Senior Care Partners |
$2.86
|
| Rate for Payer: PACE SWMI |
$3.01
|
| Rate for Payer: PHP Commercial |
$10.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.48
|
| Rate for Payer: Priority Health Medicare |
$3.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.07
|
| Rate for Payer: Railroad Medicare Medicare |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.01
|
| Rate for Payer: UHC Exchange |
$3.01
|
| Rate for Payer: UHC Medicare Advantage |
$3.01
|
| Rate for Payer: VA VA |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.04
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 00904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$57.10 |
| Rate for Payer: Aetna Commercial |
$53.93
|
| Rate for Payer: BCBS Trust/PPO |
$51.79
|
| Rate for Payer: BCN Commercial |
$49.03
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$54.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$57.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: PHP Commercial |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: Priority Health HMO/PPO |
$55.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.84
|
| Rate for Payer: UHC Core |
$52.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.59
|
|
