|
MONALISA TOUCH, SERIES, UP TO 3 VISITS
|
Professional
|
Both
|
$1,891.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$756.40 |
| Max. Negotiated Rate |
$1,418.25 |
| Rate for Payer: Aetna Medicare |
$945.50
|
| Rate for Payer: BCBS Complete |
$756.40
|
| Rate for Payer: Cash Price |
$1,512.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,418.25
|
|
|
MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES
|
Professional
|
Both
|
$630.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$238.45
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.96 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: BCBS Trust/PPO |
$196.94
|
| Rate for Payer: BCN Commercial |
$196.94
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.84
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$207.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$393.39
|
|
|
Service Code
|
NDC 13668008190
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.80 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: Aetna Commercial |
$334.38
|
| Rate for Payer: BCBS Trust/PPO |
$324.90
|
| Rate for Payer: BCN Commercial |
$324.90
|
| Rate for Payer: Cash Price |
$314.71
|
| Rate for Payer: Cofinity Commercial |
$338.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.71
|
| Rate for Payer: Healthscope Commercial |
$354.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.38
|
| Rate for Payer: Nomi Health Commercial |
$322.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.04
|
| Rate for Payer: PHP Commercial |
$334.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$342.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.18
|
| Rate for Payer: UHC Core |
$328.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.04
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
OP
|
$238.45
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.04 |
| Max. Negotiated Rate |
$214.60 |
| Rate for Payer: Aetna Commercial |
$202.68
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.52
|
| Rate for Payer: BCBS Complete |
$44.14
|
| Rate for Payer: BCBS MAPPO |
$59.61
|
| Rate for Payer: BCBS Trust/PPO |
$196.03
|
| Rate for Payer: BCN Commercial |
$196.03
|
| Rate for Payer: BCN Medicare Advantage |
$59.61
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$205.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.61
|
| Rate for Payer: Healthscope Commercial |
$214.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.84
|
| Rate for Payer: Mclaren Medicaid |
$42.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.59
|
| Rate for Payer: Meridian Medicaid |
$44.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.68
|
| Rate for Payer: Nomi Health Commercial |
$195.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.84
|
| Rate for Payer: PACE Senior Care Partners |
$56.63
|
| Rate for Payer: PACE SWMI |
$59.61
|
| Rate for Payer: PHP Commercial |
$202.68
|
| Rate for Payer: PHP Medicare Advantage |
$59.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$207.45
|
| Rate for Payer: Priority Health Medicare |
$60.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.96
|
| Rate for Payer: Railroad Medicare Medicare |
$59.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.84
|
| Rate for Payer: UHC Core |
$199.11
|
| Rate for Payer: UHC Exchange |
$59.61
|
| Rate for Payer: UHC Medicaid |
$42.04
|
| Rate for Payer: UHC Medicare Advantage |
$59.61
|
| Rate for Payer: UHCCP Medicaid |
$42.04
|
| Rate for Payer: VA VA |
$59.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.84
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
OP
|
$393.39
|
|
|
Service Code
|
NDC 13668008190
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$354.05 |
| Rate for Payer: Aetna Commercial |
$334.38
|
| Rate for Payer: Aetna Medicare |
$102.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.93
|
| Rate for Payer: BCBS Complete |
$72.82
|
| Rate for Payer: BCBS MAPPO |
$98.35
|
| Rate for Payer: BCBS Trust/PPO |
$323.41
|
| Rate for Payer: BCN Commercial |
$323.41
|
| Rate for Payer: BCN Medicare Advantage |
$98.35
|
| Rate for Payer: Cash Price |
$314.71
|
| Rate for Payer: Cofinity Commercial |
$338.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.35
|
| Rate for Payer: Healthscope Commercial |
$354.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.04
|
| Rate for Payer: Mclaren Medicaid |
$69.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.26
|
| Rate for Payer: Meridian Medicaid |
$72.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.38
|
| Rate for Payer: Nomi Health Commercial |
$322.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.04
|
| Rate for Payer: PACE Senior Care Partners |
$93.43
|
| Rate for Payer: PACE SWMI |
$98.35
|
| Rate for Payer: PHP Commercial |
$334.38
|
| Rate for Payer: PHP Medicare Advantage |
$98.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$342.25
|
| Rate for Payer: Priority Health Medicare |
$99.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.80
|
| Rate for Payer: Railroad Medicare Medicare |
$98.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.18
|
| Rate for Payer: UHC Core |
$328.48
|
| Rate for Payer: UHC Exchange |
$98.35
|
| Rate for Payer: UHC Medicaid |
$69.35
|
| Rate for Payer: UHC Medicare Advantage |
$98.35
|
| Rate for Payer: UHCCP Medicaid |
$69.35
|
| Rate for Payer: VA VA |
$98.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.04
|
|
|
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 |
$56.38 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$66.90
|
| Rate for Payer: BCN Commercial |
$66.90
|
| 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 Commercial |
$68.85
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| 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 AVERAGE PCA IV SOLUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.31
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCBS Trust/PPO |
$66.59
|
| Rate for Payer: BCN Commercial |
$66.59
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| 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: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE Senior Care Partners |
$19.24
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| Rate for Payer: Railroad Medicare Medicare |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: UHC Exchange |
$20.25
|
| Rate for Payer: UHC Medicaid |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
| Rate for Payer: UHCCP Medicaid |
$14.28
|
| Rate for Payer: VA VA |
$20.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML PCA IV SOLUTION
|
Facility
|
OP
|
$33.50
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$30.15 |
| Rate for Payer: Aetna Commercial |
$28.48
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.31
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$8.38
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCBS Trust/PPO |
$27.54
|
| Rate for Payer: BCBS Trust/PPO |
$66.59
|
| Rate for Payer: BCN Commercial |
$66.59
|
| Rate for Payer: BCN Commercial |
$27.54
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$8.38
|
| 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: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.38
|
| Rate for Payer: Healthscope Commercial |
$30.15
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Mclaren Medicaid |
$5.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.79
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.48
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: Nomi Health Commercial |
$27.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE Senior Care Partners |
$19.24
|
| Rate for Payer: PACE Senior Care Partners |
$7.96
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PACE SWMI |
$8.38
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$8.38
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.14
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$8.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| Rate for Payer: Railroad Medicare Medicare |
$8.38
|
| Rate for Payer: Railroad Medicare Medicare |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Exchange |
$20.25
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Medicaid |
$14.28
|
| Rate for Payer: UHC Medicaid |
$5.91
|
| Rate for Payer: UHC Medicare Advantage |
$8.38
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
| Rate for Payer: UHCCP Medicaid |
$5.91
|
| Rate for Payer: UHCCP Medicaid |
$14.28
|
| Rate for Payer: VA VA |
$8.38
|
| Rate for Payer: VA VA |
$20.25
|
| 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 PCA IV SOLUTION
|
Facility
|
IP
|
$33.50
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.32 |
| 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 |
$27.67
|
| Rate for Payer: BCBS Trust/PPO |
$66.90
|
| Rate for Payer: BCN Commercial |
$27.67
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: Cash Price |
$26.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$28.81
|
| 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 |
$25.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Nomi Health Commercial |
$27.47
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$27.97
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML TOLERANT PCA IV SOLUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.31
|
| Rate for Payer: BCBS Complete |
$14.99
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCBS Trust/PPO |
$66.59
|
| Rate for Payer: BCN Commercial |
$66.59
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| 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: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Mclaren Medicaid |
$14.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: Meridian Medicaid |
$14.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PACE Senior Care Partners |
$19.24
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| Rate for Payer: Railroad Medicare Medicare |
$20.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.28
|
| Rate for Payer: UHC Core |
$67.64
|
| Rate for Payer: UHC Exchange |
$20.25
|
| Rate for Payer: UHC Medicaid |
$14.28
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
| Rate for Payer: UHCCP Medicaid |
$14.28
|
| Rate for Payer: VA VA |
$20.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
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 |
$56.38 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: BCBS Trust/PPO |
$66.90
|
| Rate for Payer: BCN Commercial |
$66.90
|
| 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 Commercial |
$68.85
|
| Rate for Payer: Nomi Health Commercial |
$66.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.38
|
| 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 INJECTION SOLUTION
|
Facility
|
IP
|
$33.73
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: BCBS Trust/PPO |
$27.86
|
| Rate for Payer: BCN Commercial |
$27.86
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.98
|
| Rate for Payer: Healthscope Commercial |
$30.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.67
|
| Rate for Payer: Nomi Health Commercial |
$27.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.30
|
| Rate for Payer: PHP Commercial |
$28.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.68
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.30
|
|
|
MORPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$33.73
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.54
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS MAPPO |
$8.43
|
| Rate for Payer: BCBS Trust/PPO |
$27.73
|
| Rate for Payer: BCN Commercial |
$27.73
|
| Rate for Payer: BCN Medicare Advantage |
$8.43
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.43
|
| Rate for Payer: Healthscope Commercial |
$30.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.30
|
| Rate for Payer: Mclaren Medicaid |
$5.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.85
|
| Rate for Payer: Meridian Medicaid |
$6.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.67
|
| Rate for Payer: Nomi Health Commercial |
$27.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.30
|
| Rate for Payer: PACE Senior Care Partners |
$8.01
|
| Rate for Payer: PACE SWMI |
$8.43
|
| Rate for Payer: PHP Commercial |
$28.67
|
| Rate for Payer: PHP Medicare Advantage |
$8.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.35
|
| Rate for Payer: Priority Health Medicare |
$8.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.48
|
| Rate for Payer: Railroad Medicare Medicare |
$8.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.68
|
| Rate for Payer: UHC Core |
$28.16
|
| Rate for Payer: UHC Exchange |
$8.43
|
| Rate for Payer: UHC Medicaid |
$5.95
|
| Rate for Payer: UHC Medicare Advantage |
$8.43
|
| Rate for Payer: UHCCP Medicaid |
$5.95
|
| Rate for Payer: VA VA |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.30
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCN Commercial |
$14.43
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.47
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCN Commercial |
$14.36
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: PACE Senior Care Partners |
$4.15
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Exchange |
$4.37
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.37
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: BCBS Trust/PPO |
$13.64
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$13.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.39
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.54
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.39
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare |
$4.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.16
|
| Rate for Payer: BCBS Complete |
$3.06
|
| Rate for Payer: BCBS MAPPO |
$4.13
|
| Rate for Payer: BCBS Trust/PPO |
$13.58
|
| Rate for Payer: BCN Commercial |
$13.58
|
| Rate for Payer: BCN Medicare Advantage |
$4.13
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.39
|
| Rate for Payer: Mclaren Medicaid |
$2.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.34
|
| Rate for Payer: Meridian Medicaid |
$3.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$13.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.39
|
| Rate for Payer: PACE Senior Care Partners |
$3.92
|
| Rate for Payer: PACE SWMI |
$4.13
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: PHP Medicare Advantage |
$4.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.37
|
| Rate for Payer: Priority Health Medicare |
$4.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.54
|
| Rate for Payer: UHC Core |
$13.79
|
| Rate for Payer: UHC Exchange |
$4.13
|
| Rate for Payer: UHC Medicaid |
$2.91
|
| Rate for Payer: UHC Medicare Advantage |
$4.13
|
| Rate for Payer: UHCCP Medicaid |
$2.91
|
| Rate for Payer: VA VA |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.39
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$527.10
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$366.86 |
| Max. Negotiated Rate |
$474.39 |
| Rate for Payer: Aetna Commercial |
$448.04
|
| Rate for Payer: BCBS Trust/PPO |
$435.33
|
| Rate for Payer: BCN Commercial |
$435.33
|
| Rate for Payer: Cash Price |
$421.68
|
| Rate for Payer: Cofinity Commercial |
$453.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$421.68
|
| Rate for Payer: Healthscope Commercial |
$474.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$395.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$448.04
|
| Rate for Payer: Nomi Health Commercial |
$432.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$395.32
|
| Rate for Payer: PHP Commercial |
$448.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$458.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$366.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.85
|
| Rate for Payer: UHC Core |
$440.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$395.32
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 60687061711
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.22
|
| Rate for Payer: BCN Commercial |
$4.22
|
| 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 Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.83
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.56
|
| 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
|
OP
|
$5.28
|
|
|
Service Code
|
NDC 00406511823
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.65
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS MAPPO |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.34
|
| Rate for Payer: BCN Commercial |
$4.34
|
| Rate for Payer: BCN Medicare Advantage |
$1.32
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Mclaren Medicaid |
$0.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.39
|
| Rate for Payer: Meridian Medicaid |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: Nomi Health Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.96
|
| Rate for Payer: PACE Senior Care Partners |
$1.25
|
| Rate for Payer: PACE SWMI |
$1.32
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: PHP Medicare Advantage |
$1.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.59
|
| Rate for Payer: Priority Health Medicare |
$1.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$4.41
|
| Rate for Payer: UHC Exchange |
$1.32
|
| Rate for Payer: UHC Medicaid |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$1.32
|
| Rate for Payer: UHCCP Medicaid |
$0.93
|
| Rate for Payer: VA VA |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$5.28
|
|
|
Service Code
|
NDC 00406511823
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.36
|
| Rate for Payer: BCN Commercial |
$4.36
|
| Rate for Payer: Cash Price |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.22
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.49
|
| Rate for Payer: Nomi Health Commercial |
$4.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.96
|
| Rate for Payer: PHP Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.65
|
| Rate for Payer: UHC Core |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.96
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 60687061711
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.60
|
| Rate for Payer: BCBS Complete |
$0.95
|
| Rate for Payer: BCBS MAPPO |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.20
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: BCN Medicare Advantage |
$1.28
|
| 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: Health Alliance Plan Medicare Advantage |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.83
|
| Rate for Payer: Mclaren Medicaid |
$0.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: Meridian Medicaid |
$0.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.83
|
| Rate for Payer: PACE Senior Care Partners |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.28
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: PHP Medicare Advantage |
$1.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.45
|
| Rate for Payer: Priority Health Medicare |
$1.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.50
|
| Rate for Payer: UHC Core |
$4.27
|
| Rate for Payer: UHC Exchange |
$1.28
|
| Rate for Payer: UHC Medicaid |
$0.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.28
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: VA VA |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$123.38
|
|
|
Service Code
|
NDC 00054023524
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.87 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: BCBS Trust/PPO |
$101.90
|
| Rate for Payer: BCN Commercial |
$101.90
|
| 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 |
$92.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$101.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.53
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.87
|
| 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 |
$92.53
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$542.50
|
|
|
Service Code
|
NDC 00054023525
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$461.12
|
| Rate for Payer: Aetna Medicare |
$141.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$169.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$169.53
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$135.62
|
| Rate for Payer: BCBS Trust/PPO |
$445.99
|
| Rate for Payer: BCN Commercial |
$445.99
|
| Rate for Payer: BCN Medicare Advantage |
$135.62
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cofinity Commercial |
$466.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$434.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.62
|
| Rate for Payer: Healthscope Commercial |
$488.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.88
|
| Rate for Payer: Mclaren Medicaid |
$95.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.41
|
| Rate for Payer: Meridian Medicaid |
$100.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$149.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$461.12
|
| Rate for Payer: Nomi Health Commercial |
$444.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$406.88
|
| Rate for Payer: PACE Senior Care Partners |
$128.84
|
| Rate for Payer: PACE SWMI |
$135.62
|
| Rate for Payer: PHP Commercial |
$461.12
|
| Rate for Payer: PHP Medicare Advantage |
$135.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$471.98
|
| Rate for Payer: Priority Health Medicare |
$136.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$377.58
|
| Rate for Payer: Railroad Medicare Medicare |
$135.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$477.40
|
| Rate for Payer: UHC Core |
$452.99
|
| Rate for Payer: UHC Exchange |
$135.62
|
| Rate for Payer: UHC Medicaid |
$95.64
|
| Rate for Payer: UHC Medicare Advantage |
$135.62
|
| Rate for Payer: UHCCP Medicaid |
$95.64
|
| Rate for Payer: VA VA |
$135.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.88
|
|
