|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$8.01
|
|
|
Service Code
|
NDC 68084-636-95
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Aetna Commercial |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$6.19
|
| Rate for Payer: BCN Commercial |
$6.19
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$7.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.81
|
| Rate for Payer: PHP Commercial |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.05
|
| Rate for Payer: UHC Core |
$6.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.01
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$154.80
|
|
|
Service Code
|
NDC 0904-7161-04
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.41 |
| Max. Negotiated Rate |
$139.32 |
| Rate for Payer: Aetna Commercial |
$131.58
|
| Rate for Payer: BCBS Trust/PPO |
$119.63
|
| Rate for Payer: BCN Commercial |
$119.63
|
| Rate for Payer: Cash Price |
$123.84
|
| Rate for Payer: Cofinity Commercial |
$133.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.84
|
| Rate for Payer: Healthscope Commercial |
$139.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.58
|
| Rate for Payer: PHP Commercial |
$131.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.22
|
| Rate for Payer: UHC Core |
$129.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.10
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$175.68
|
|
|
Service Code
|
NDC 60687-629-21
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$149.33
|
| Rate for Payer: BCBS Trust/PPO |
$135.77
|
| Rate for Payer: BCN Commercial |
$135.77
|
| Rate for Payer: Cash Price |
$140.54
|
| Rate for Payer: Cofinity Commercial |
$151.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.54
|
| Rate for Payer: Healthscope Commercial |
$158.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.33
|
| Rate for Payer: PHP Commercial |
$149.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.60
|
| Rate for Payer: UHC Core |
$146.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.76
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$5.56
|
|
|
Service Code
|
NDC 68084-635-11
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: BCBS Trust/PPO |
$4.30
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.89
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$166.61
|
|
|
Service Code
|
NDC 68084-635-21
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.62 |
| Max. Negotiated Rate |
$149.95 |
| Rate for Payer: Aetna Commercial |
$141.62
|
| Rate for Payer: BCBS Trust/PPO |
$128.76
|
| Rate for Payer: BCN Commercial |
$128.76
|
| Rate for Payer: Cash Price |
$133.29
|
| Rate for Payer: Cofinity Commercial |
$143.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.29
|
| Rate for Payer: Healthscope Commercial |
$149.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.62
|
| Rate for Payer: PHP Commercial |
$141.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.62
|
| Rate for Payer: UHC Core |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.96
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$3.61
|
|
|
Service Code
|
NDC 60687-618-11
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.18
|
| Rate for Payer: UHC Core |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$108.15
|
|
|
Service Code
|
NDC 60687-618-21
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.96 |
| Max. Negotiated Rate |
$97.34 |
| Rate for Payer: Aetna Commercial |
$91.93
|
| Rate for Payer: BCBS Trust/PPO |
$83.58
|
| Rate for Payer: BCN Commercial |
$83.58
|
| Rate for Payer: Cash Price |
$86.52
|
| Rate for Payer: Cofinity Commercial |
$93.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.52
|
| Rate for Payer: Healthscope Commercial |
$97.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.93
|
| Rate for Payer: PHP Commercial |
$91.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.17
|
| Rate for Payer: UHC Core |
$90.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.11
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 69097-459-05
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.87 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: BCBS Trust/PPO |
$168.35
|
| Rate for Payer: BCN Commercial |
$168.35
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Core |
$181.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$92.12
|
|
|
Service Code
|
NDC 60505-7014-2
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$82.91 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: BCBS Trust/PPO |
$71.19
|
| Rate for Payer: BCN Commercial |
$71.19
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.70
|
| Rate for Payer: Healthscope Commercial |
$82.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.30
|
| Rate for Payer: PHP Commercial |
$78.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.07
|
| Rate for Payer: UHC Core |
$76.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.09
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$59.54
|
|
|
Service Code
|
NDC 60505-7084-0
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$53.59 |
| Rate for Payer: Aetna Commercial |
$50.61
|
| Rate for Payer: BCBS Trust/PPO |
$46.01
|
| Rate for Payer: BCN Commercial |
$46.01
|
| Rate for Payer: Cash Price |
$47.63
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.63
|
| Rate for Payer: Healthscope Commercial |
$53.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.61
|
| Rate for Payer: PHP Commercial |
$50.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.40
|
| Rate for Payer: UHC Core |
$49.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.66
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 60505-7014-0
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$16.59 |
| Rate for Payer: Aetna Commercial |
$15.67
|
| Rate for Payer: BCBS Trust/PPO |
$14.24
|
| Rate for Payer: BCN Commercial |
$14.24
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.67
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.22
|
| Rate for Payer: UHC Core |
$15.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$297.70
|
|
|
Service Code
|
NDC 60505-7084-2
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.57 |
| Max. Negotiated Rate |
$267.93 |
| Rate for Payer: Aetna Commercial |
$253.04
|
| Rate for Payer: BCBS Trust/PPO |
$230.06
|
| Rate for Payer: BCN Commercial |
$230.06
|
| Rate for Payer: Cash Price |
$238.16
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.16
|
| Rate for Payer: Healthscope Commercial |
$267.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.04
|
| Rate for Payer: PHP Commercial |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.98
|
| Rate for Payer: UHC Core |
$248.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.28
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$153.22
|
|
|
Service Code
|
NDC 0378-9119-16
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna Commercial |
$130.24
|
| Rate for Payer: BCBS Trust/PPO |
$118.41
|
| Rate for Payer: BCN Commercial |
$118.41
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$131.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.24
|
| Rate for Payer: PHP Commercial |
$130.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.83
|
| Rate for Payer: UHC Core |
$127.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.92
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$153.22
|
|
|
Service Code
|
NDC 0378-9119-98
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.45 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna Commercial |
$130.24
|
| Rate for Payer: BCBS Trust/PPO |
$118.41
|
| Rate for Payer: BCN Commercial |
$118.41
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$131.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Healthscope Commercial |
$137.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.24
|
| Rate for Payer: PHP Commercial |
$130.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.83
|
| Rate for Payer: UHC Core |
$127.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.92
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$46.69
|
|
|
Service Code
|
NDC 60505-7006-2
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.48 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna Commercial |
$39.69
|
| Rate for Payer: BCBS Trust/PPO |
$36.08
|
| Rate for Payer: BCN Commercial |
$36.08
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cofinity Commercial |
$40.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.35
|
| Rate for Payer: Healthscope Commercial |
$42.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.69
|
| Rate for Payer: PHP Commercial |
$39.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.09
|
| Rate for Payer: UHC Core |
$38.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$16.57
|
|
|
Service Code
|
NDC 60505-7081-0
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$14.91 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.81
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cofinity Commercial |
$14.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.08
|
| Rate for Payer: PHP Commercial |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.43
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$82.84
|
|
|
Service Code
|
NDC 60505-7081-2
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.52 |
| Max. Negotiated Rate |
$74.56 |
| Rate for Payer: Aetna Commercial |
$70.41
|
| Rate for Payer: BCBS Trust/PPO |
$64.02
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: Cash Price |
$66.27
|
| Rate for Payer: Cofinity Commercial |
$71.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.27
|
| Rate for Payer: Healthscope Commercial |
$74.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.41
|
| Rate for Payer: PHP Commercial |
$70.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.90
|
| Rate for Payer: UHC Core |
$69.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.13
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 60505-7006-0
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Aetna Commercial |
$7.94
|
| Rate for Payer: BCBS Trust/PPO |
$7.22
|
| Rate for Payer: BCN Commercial |
$7.22
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$8.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$8.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.94
|
| Rate for Payer: PHP Commercial |
$7.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.22
|
| Rate for Payer: UHC Core |
$7.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.00
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$150.39
|
|
|
Service Code
|
NDC 60505-7082-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.72 |
| Max. Negotiated Rate |
$135.35 |
| Rate for Payer: Aetna Commercial |
$127.83
|
| Rate for Payer: BCBS Trust/PPO |
$116.22
|
| Rate for Payer: BCN Commercial |
$116.22
|
| Rate for Payer: Cash Price |
$120.31
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.31
|
| Rate for Payer: Healthscope Commercial |
$135.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.83
|
| Rate for Payer: PHP Commercial |
$127.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.34
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.79
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$30.08
|
|
|
Service Code
|
NDC 60505-7082-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Aetna Commercial |
$25.57
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| 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 Multiplan/Beech St/PHCS |
$25.57
|
| Rate for Payer: PHP Commercial |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.35
|
| 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
|
$15.65
|
|
|
Service Code
|
NDC 60505-7007-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna Commercial |
$13.30
|
| Rate for Payer: BCBS Trust/PPO |
$12.09
|
| Rate for Payer: BCN Commercial |
$12.09
|
| Rate for Payer: Cash Price |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.52
|
| Rate for Payer: Healthscope Commercial |
$14.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.30
|
| Rate for Payer: PHP Commercial |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.77
|
| Rate for Payer: UHC Core |
$13.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$193.65
|
|
|
Service Code
|
NDC 0406-9050-76
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.11 |
| Max. Negotiated Rate |
$174.28 |
| Rate for Payer: Aetna Commercial |
$164.60
|
| Rate for Payer: BCBS Trust/PPO |
$149.65
|
| 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 Multiplan/Beech St/PHCS |
$164.60
|
| Rate for Payer: PHP Commercial |
$164.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.11
|
| 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
|
$113.49
|
|
|
Service Code
|
NDC 47781-426-47
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Aetna Commercial |
$96.47
|
| Rate for Payer: BCBS Trust/PPO |
$87.71
|
| Rate for Payer: BCN Commercial |
$87.71
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$97.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.79
|
| Rate for Payer: Healthscope Commercial |
$102.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.47
|
| Rate for Payer: PHP Commercial |
$96.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.87
|
| Rate for Payer: UHC Core |
$94.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.12
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$198.53
|
|
|
Service Code
|
NDC 0378-9122-98
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$178.68 |
| Rate for Payer: Aetna Commercial |
$168.75
|
| Rate for Payer: BCBS Trust/PPO |
$153.42
|
| 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 Multiplan/Beech St/PHCS |
$168.75
|
| Rate for Payer: PHP Commercial |
$168.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.08
|
| 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
|
IP
|
$78.24
|
|
|
Service Code
|
NDC 60505-7007-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: BCBS Trust/PPO |
$60.46
|
| Rate for Payer: BCN Commercial |
$60.46
|
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Cofinity Commercial |
$67.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.59
|
| Rate for Payer: Healthscope Commercial |
$70.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.50
|
| Rate for Payer: PHP Commercial |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.85
|
| Rate for Payer: UHC Core |
$65.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.68
|
|
