|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$236.55
|
|
|
Service Code
|
NDC 0904-6808-61
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.27 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: BCBS Trust/PPO |
$182.81
|
| Rate for Payer: BCN Commercial |
$182.81
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.16
|
| Rate for Payer: UHC Core |
$197.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 13668-081-90
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: BCBS Trust/PPO |
$98.07
|
| Rate for Payer: BCN Commercial |
$98.07
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.86
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.67
|
| Rate for Payer: UHC Core |
$105.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.18
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$62.60
|
| Rate for Payer: BCN Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML PCA IV SOLUTION
|
Facility
|
IP
|
$33.50
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.43 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCBS Trust/PPO |
$62.60
|
| Rate for Payer: BCN Commercial |
$62.60
|
| Rate for Payer: BCN Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$28.81
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.80
|
| Rate for Payer: Healthscope Commercial |
$30.15
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.48
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.12
|
|
|
MORPHINE 100MG/100ML TOLERANT PCA IV SOLUTION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$62.60
|
| Rate for Payer: BCN Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.19
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Aetna Commercial |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.28
|
| Rate for Payer: BCN Commercial |
$13.28
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.75
|
| Rate for Payer: Healthscope Commercial |
$15.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.61
|
| Rate for Payer: PHP Commercial |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.13
|
| Rate for Payer: UHC Core |
$14.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.89
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$123.38
|
|
|
Service Code
|
NDC 0054-0235-24
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: BCBS Trust/PPO |
$95.35
|
| Rate for Payer: BCN Commercial |
$95.35
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$111.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.87
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.57
|
| Rate for Payer: UHC Core |
$103.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.54
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 60687-617-11
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$3.95
|
| Rate for Payer: BCN Commercial |
$3.95
|
| Rate for Payer: Cash Price |
$4.09
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.34
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.50
|
| Rate for Payer: UHC Core |
$4.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
NDC 60687-617-01
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.66 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: BCBS Trust/PPO |
$394.90
|
| Rate for Payer: BCN Commercial |
$394.90
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.35
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$444.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.68
|
| Rate for Payer: UHC Core |
$426.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
MORPHINE 1 MG/ML IV INFUSION (IV PREMIX) 100 ML
|
Facility
|
IP
|
$33.50
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
151077
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.43 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cofinity Commercial |
$28.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.80
|
| Rate for Payer: Healthscope Commercial |
$30.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.48
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.12
|
|
|
MORPHINE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$17.06
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: BCBS Trust/PPO |
$19.15
|
| Rate for Payer: BCBS Trust/PPO |
$13.18
|
| Rate for Payer: BCN Commercial |
$13.18
|
| Rate for Payer: BCN Commercial |
$19.15
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.06
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.81
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: UHC Core |
$20.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.58
|
|
|
MORPHINE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$14.39
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: BCBS Trust/PPO |
$11.12
|
| Rate for Payer: BCN Commercial |
$11.12
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.23
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.66
|
| Rate for Payer: UHC Core |
$12.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
|
|
MORPHINE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$30.64
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
186563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$27.58 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: BCBS Trust/PPO |
$23.68
|
| Rate for Payer: BCN Commercial |
$23.68
|
| Rate for Payer: Cash Price |
$24.51
|
| Rate for Payer: Cofinity Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.51
|
| Rate for Payer: Healthscope Commercial |
$27.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.04
|
| Rate for Payer: PHP Commercial |
$26.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.96
|
| Rate for Payer: UHC Core |
$25.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.98
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Commercial |
$17.65
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.15
|
| Rate for Payer: BCN Commercial |
$19.15
|
| Rate for Payer: BCN Commercial |
$16.05
|
| Rate for Payer: BCN Commercial |
$11.94
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.65
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: PHP Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.81
|
| Rate for Payer: UHC Core |
$17.34
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: UHC Core |
$20.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$25.81
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.74 |
| Max. Negotiated Rate |
$23.23 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Commercial |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$11.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCN Commercial |
$19.95
|
| Rate for Payer: BCN Commercial |
$11.38
|
| Rate for Payer: Cash Price |
$20.65
|
| Rate for Payer: Cash Price |
$11.78
|
| Rate for Payer: Cofinity Commercial |
$12.66
|
| Rate for Payer: Cofinity Commercial |
$22.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$23.23
|
| Rate for Payer: Healthscope Commercial |
$13.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.94
|
| Rate for Payer: PHP Commercial |
$21.94
|
| Rate for Payer: PHP Commercial |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.95
|
| Rate for Payer: UHC Core |
$12.29
|
| Rate for Payer: UHC Core |
$21.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.36
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$135.98
|
|
|
Service Code
|
NDC 0054-0517-44
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.93 |
| Max. Negotiated Rate |
$122.38 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: BCBS Trust/PPO |
$105.09
|
| Rate for Payer: BCN Commercial |
$105.09
|
| Rate for Payer: Cash Price |
$108.78
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.78
|
| Rate for Payer: Healthscope Commercial |
$122.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.58
|
| Rate for Payer: PHP Commercial |
$115.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.66
|
| Rate for Payer: UHC Core |
$113.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.98
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$516.60
|
|
|
Service Code
|
NDC 0054-0517-50
|
| Hospital Charge Code |
10655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$464.94 |
| Rate for Payer: Aetna Commercial |
$439.11
|
| Rate for Payer: BCBS Trust/PPO |
$399.23
|
| Rate for Payer: BCN Commercial |
$399.23
|
| Rate for Payer: Cash Price |
$413.28
|
| Rate for Payer: Cofinity Commercial |
$444.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.28
|
| Rate for Payer: Healthscope Commercial |
$464.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$387.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.11
|
| Rate for Payer: PHP Commercial |
$439.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$449.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$315.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.61
|
| Rate for Payer: UHC Core |
$431.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$387.45
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 68094-056-01
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.94
|
| Rate for Payer: PHP Commercial |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.30
|
| Rate for Payer: UHC Core |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.78
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.70
|
|
|
Service Code
|
NDC 68094-056-58
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.94
|
| Rate for Payer: PHP Commercial |
$9.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.30
|
| Rate for Payer: UHC Core |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.78
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
NDC 68094-045-01
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.30
|
| Rate for Payer: BCN Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$9.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.13
|
| Rate for Payer: PHP Commercial |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.45
|
| Rate for Payer: UHC Core |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.06
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
NDC 68094-045-58
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Aetna Commercial |
$9.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.30
|
| Rate for Payer: BCN Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$9.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$9.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.13
|
| Rate for Payer: PHP Commercial |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.45
|
| Rate for Payer: UHC Core |
$8.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.06
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$495.60
|
|
|
Service Code
|
NDC 42858-804-01
|
| Hospital Charge Code |
20919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.27 |
| Max. Negotiated Rate |
$446.04 |
| Rate for Payer: Aetna Commercial |
$421.26
|
| Rate for Payer: BCBS Trust/PPO |
$383.00
|
| Rate for Payer: BCN Commercial |
$383.00
|
| Rate for Payer: Cash Price |
$396.48
|
| Rate for Payer: Cofinity Commercial |
$426.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.48
|
| Rate for Payer: Healthscope Commercial |
$446.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$421.26
|
| Rate for Payer: PHP Commercial |
$421.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$431.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.13
|
| Rate for Payer: UHC Core |
$413.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.70
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$911.75
|
|
|
Service Code
|
NDC 0904-6557-61
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.08 |
| Max. Negotiated Rate |
$820.58 |
| Rate for Payer: Aetna Commercial |
$774.99
|
| Rate for Payer: BCBS Trust/PPO |
$704.60
|
| Rate for Payer: BCN Commercial |
$704.60
|
| Rate for Payer: Cash Price |
$729.40
|
| Rate for Payer: Cofinity Commercial |
$784.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.40
|
| Rate for Payer: Healthscope Commercial |
$820.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.99
|
| Rate for Payer: PHP Commercial |
$774.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$556.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$802.34
|
| Rate for Payer: UHC Core |
$761.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.81
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$545.30
|
|
|
Service Code
|
NDC 0406-8315-62
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.58 |
| Max. Negotiated Rate |
$490.77 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: BCBS Trust/PPO |
$421.41
|
| Rate for Payer: BCN Commercial |
$421.41
|
| Rate for Payer: Cash Price |
$436.24
|
| Rate for Payer: Cofinity Commercial |
$468.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.24
|
| Rate for Payer: Healthscope Commercial |
$490.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$408.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.50
|
| Rate for Payer: PHP Commercial |
$463.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$332.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.86
|
| Rate for Payer: UHC Core |
$455.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$408.98
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$346.50
|
|
|
Service Code
|
NDC 42858-801-01
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.33 |
| Max. Negotiated Rate |
$311.85 |
| Rate for Payer: Aetna Commercial |
$294.52
|
| Rate for Payer: BCBS Trust/PPO |
$267.78
|
| Rate for Payer: BCN Commercial |
$267.78
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cofinity Commercial |
$297.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.20
|
| Rate for Payer: Healthscope Commercial |
$311.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.52
|
| Rate for Payer: PHP Commercial |
$294.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.92
|
| Rate for Payer: UHC Core |
$289.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.88
|
|
