|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.48
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$9.14
|
| Rate for Payer: BCN Commercial |
$8.65
|
| Rate for Payer: BCN Medicare Advantage |
$2.78
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: PACE Senior Care Partners |
$2.64
|
| Rate for Payer: PACE SWMI |
$2.78
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Medicare |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.45
|
| Rate for Payer: Railroad Medicare Medicare |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.78
|
| Rate for Payer: UHC Exchange |
$2.78
|
| Rate for Payer: UHC Medicare Advantage |
$2.78
|
| Rate for Payer: VA VA |
$2.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.08
|
| Rate for Payer: BCN Commercial |
$8.59
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.48
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$9.14
|
| Rate for Payer: BCN Commercial |
$8.65
|
| Rate for Payer: BCN Medicare Advantage |
$2.78
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: PACE Senior Care Partners |
$2.64
|
| Rate for Payer: PACE SWMI |
$2.78
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health HMO/PPO |
$9.67
|
| Rate for Payer: Priority Health Medicare |
$2.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.45
|
| Rate for Payer: Railroad Medicare Medicare |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$9.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.78
|
| Rate for Payer: UHC Exchange |
$2.78
|
| Rate for Payer: UHC Medicare Advantage |
$2.78
|
| Rate for Payer: VA VA |
$2.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: BCBS Trust/PPO |
$457.13
|
| Rate for Payer: BCN Commercial |
$432.77
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO |
$487.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.80
|
| Rate for Payer: UHC Core |
$467.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna Commercial |
$783.91
|
| Rate for Payer: Aetna Medicare |
$239.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$288.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$288.20
|
| Rate for Payer: BCBS Complete |
$368.90
|
| Rate for Payer: BCBS MAPPO |
$230.56
|
| Rate for Payer: BCBS Trust/PPO |
$758.18
|
| Rate for Payer: BCN Commercial |
$717.05
|
| Rate for Payer: BCN Medicare Advantage |
$230.56
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$793.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.56
|
| Rate for Payer: Healthscope Commercial |
$830.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$265.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: Nomi Health Commercial |
$756.25
|
| Rate for Payer: PACE Senior Care Partners |
$219.03
|
| Rate for Payer: PACE SWMI |
$230.56
|
| Rate for Payer: PHP Commercial |
$783.91
|
| Rate for Payer: PHP Medicare Advantage |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: Priority Health HMO/PPO |
$802.36
|
| Rate for Payer: Priority Health Medicare |
$232.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.91
|
| Rate for Payer: Railroad Medicare Medicare |
$230.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.58
|
| Rate for Payer: UHC Core |
$770.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.56
|
| Rate for Payer: UHC Exchange |
$230.56
|
| Rate for Payer: UHC Medicare Advantage |
$230.56
|
| Rate for Payer: VA VA |
$230.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.69
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.15 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: BCBS Trust/PPO |
$417.13
|
| 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 Commercial |
$434.35
|
| Rate for Payer: Nomi Health Commercial |
$419.02
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: Priority Health HMO/PPO |
$444.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.68
|
| Rate for Payer: UHC Core |
$426.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.11
|
|
|
Service Code
|
NDC 00406831523
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.17
|
| 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 Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.19
|
| Rate for Payer: PHP Commercial |
$4.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO |
$4.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.42
|
| 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 ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$5.11
|
|
|
Service Code
|
NDC 00406831523
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| 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 |
$2.04
|
| Rate for Payer: BCBS MAPPO |
$1.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.20
|
| Rate for Payer: BCN Commercial |
$3.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.34
|
| Rate for Payer: Nomi Health Commercial |
$4.19
|
| 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 Cigna Priority Health |
$3.32
|
| Rate for Payer: Priority Health HMO/PPO |
$4.45
|
| Rate for Payer: Priority Health Medicare |
$1.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.42
|
| 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 Dual Complete DSNP |
$1.28
|
| Rate for Payer: UHC Exchange |
$1.28
|
| Rate for Payer: UHC Medicare Advantage |
$1.28
|
| Rate for Payer: VA VA |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.83
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna Medicare |
$145.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$175.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$175.00
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$460.38
|
| Rate for Payer: BCN Commercial |
$435.40
|
| Rate for Payer: BCN Medicare Advantage |
$140.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: Nomi Health Commercial |
$459.20
|
| Rate for Payer: PACE Senior Care Partners |
$133.00
|
| Rate for Payer: PACE SWMI |
$140.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: PHP Medicare Advantage |
$140.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health HMO/PPO |
$487.20
|
| Rate for Payer: Priority Health Medicare |
$141.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$375.20
|
| Rate for Payer: Railroad Medicare Medicare |
$140.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.80
|
| Rate for Payer: UHC Core |
$467.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.00
|
| Rate for Payer: UHC Exchange |
$140.00
|
| Rate for Payer: UHC Medicare Advantage |
$140.00
|
| Rate for Payer: VA VA |
$140.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$132.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$159.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$159.69
|
| Rate for Payer: BCBS Complete |
$204.40
|
| Rate for Payer: BCBS MAPPO |
$127.75
|
| Rate for Payer: BCBS Trust/PPO |
$420.09
|
| Rate for Payer: BCN Commercial |
$397.30
|
| Rate for Payer: BCN Medicare Advantage |
$127.75
|
| 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: Health Alliance Plan Medicare Advantage |
$127.75
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.35
|
| Rate for Payer: Nomi Health Commercial |
$419.02
|
| Rate for Payer: PACE Senior Care Partners |
$121.36
|
| Rate for Payer: PACE SWMI |
$127.75
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: PHP Medicare Advantage |
$127.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: Priority Health HMO/PPO |
$444.57
|
| Rate for Payer: Priority Health Medicare |
$129.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$342.37
|
| Rate for Payer: Railroad Medicare Medicare |
$127.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.68
|
| Rate for Payer: UHC Core |
$426.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.75
|
| Rate for Payer: UHC Exchange |
$127.75
|
| Rate for Payer: UHC Medicare Advantage |
$127.75
|
| Rate for Payer: VA VA |
$127.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.46 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna Commercial |
$783.91
|
| Rate for Payer: BCBS Trust/PPO |
$752.83
|
| Rate for Payer: BCN Commercial |
$712.71
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$793.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Healthscope Commercial |
$830.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: Nomi Health Commercial |
$756.25
|
| Rate for Payer: PHP Commercial |
$783.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: Priority Health HMO/PPO |
$802.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.58
|
| Rate for Payer: UHC Core |
$770.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.69
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$787.50
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.03 |
| Max. Negotiated Rate |
$708.75 |
| Rate for Payer: Aetna Commercial |
$669.38
|
| Rate for Payer: Aetna Medicare |
$204.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.09
|
| Rate for Payer: BCBS Complete |
$315.00
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCBS Trust/PPO |
$647.40
|
| Rate for Payer: BCN Commercial |
$612.28
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cofinity Commercial |
$677.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Healthscope Commercial |
$708.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.38
|
| Rate for Payer: Nomi Health Commercial |
$645.75
|
| Rate for Payer: PACE Senior Care Partners |
$187.03
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PHP Commercial |
$669.38
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.88
|
| Rate for Payer: Priority Health HMO/PPO |
$685.12
|
| Rate for Payer: Priority Health Medicare |
$198.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.62
|
| Rate for Payer: Railroad Medicare Medicare |
$196.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.00
|
| Rate for Payer: UHC Core |
$657.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Exchange |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
| Rate for Payer: VA VA |
$196.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.62
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$717.50
|
|
|
Service Code
|
NDC 00904655861
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.41 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Aetna Commercial |
$609.88
|
| Rate for Payer: Aetna Medicare |
$186.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$224.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$224.22
|
| Rate for Payer: BCBS Complete |
$287.00
|
| Rate for Payer: BCBS MAPPO |
$179.38
|
| Rate for Payer: BCBS Trust/PPO |
$589.86
|
| Rate for Payer: BCN Commercial |
$557.86
|
| Rate for Payer: BCN Medicare Advantage |
$179.38
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$617.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.38
|
| Rate for Payer: Healthscope Commercial |
$645.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.88
|
| Rate for Payer: Nomi Health Commercial |
$588.35
|
| Rate for Payer: PACE Senior Care Partners |
$170.41
|
| Rate for Payer: PACE SWMI |
$179.38
|
| Rate for Payer: PHP Commercial |
$609.88
|
| Rate for Payer: PHP Medicare Advantage |
$179.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.38
|
| Rate for Payer: Priority Health HMO/PPO |
$624.23
|
| Rate for Payer: Priority Health Medicare |
$181.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.73
|
| Rate for Payer: Railroad Medicare Medicare |
$179.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.40
|
| Rate for Payer: UHC Core |
$599.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.38
|
| Rate for Payer: UHC Exchange |
$179.38
|
| Rate for Payer: UHC Medicare Advantage |
$179.38
|
| Rate for Payer: VA VA |
$179.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.12
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$511.88 |
| Max. Negotiated Rate |
$708.75 |
| Rate for Payer: Aetna Commercial |
$669.38
|
| Rate for Payer: BCBS Trust/PPO |
$642.84
|
| Rate for Payer: BCN Commercial |
$608.58
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cofinity Commercial |
$677.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.00
|
| Rate for Payer: Healthscope Commercial |
$708.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.38
|
| Rate for Payer: Nomi Health Commercial |
$645.75
|
| Rate for Payer: PHP Commercial |
$669.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.88
|
| Rate for Payer: Priority Health HMO/PPO |
$685.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$527.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.00
|
| Rate for Payer: UHC Core |
$657.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.62
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$717.50
|
|
|
Service Code
|
NDC 00904655861
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$466.38 |
| Max. Negotiated Rate |
$645.75 |
| Rate for Payer: Aetna Commercial |
$609.88
|
| Rate for Payer: BCBS Trust/PPO |
$585.70
|
| Rate for Payer: BCN Commercial |
$554.48
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$617.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.00
|
| Rate for Payer: Healthscope Commercial |
$645.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$538.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.88
|
| Rate for Payer: Nomi Health Commercial |
$588.35
|
| Rate for Payer: PHP Commercial |
$609.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.38
|
| Rate for Payer: Priority Health HMO/PPO |
$624.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$631.40
|
| Rate for Payer: UHC Core |
$599.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$538.12
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.53
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.65
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS MAPPO |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: BCN Medicare Advantage |
$2.92
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PACE Senior Care Partners |
$2.77
|
| Rate for Payer: PACE SWMI |
$2.92
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.92
|
| Rate for Payer: UHC Exchange |
$2.92
|
| Rate for Payer: UHC Medicare Advantage |
$2.92
|
| Rate for Payer: VA VA |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.65
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS MAPPO |
$2.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.60
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: BCN Medicare Advantage |
$2.92
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PACE Senior Care Partners |
$2.77
|
| Rate for Payer: PACE SWMI |
$2.92
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: PHP Medicare Advantage |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Medicare |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.92
|
| Rate for Payer: UHC Exchange |
$2.92
|
| Rate for Payer: UHC Medicare Advantage |
$2.92
|
| Rate for Payer: VA VA |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: BCBS Trust/PPO |
$9.53
|
| Rate for Payer: BCN Commercial |
$9.03
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$9.58
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health HMO/PPO |
$10.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.28
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: BCBS Trust/PPO |
$224.97
|
| Rate for Payer: BCN Commercial |
$212.98
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health HMO/PPO |
$239.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.53
|
| Rate for Payer: UHC Core |
$230.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Medicare |
$48.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.50
|
| Rate for Payer: BCBS Complete |
$74.88
|
| Rate for Payer: BCBS MAPPO |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.90
|
| Rate for Payer: BCN Commercial |
$145.55
|
| Rate for Payer: BCN Medicare Advantage |
$46.80
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.80
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Nomi Health Commercial |
$153.50
|
| Rate for Payer: PACE Senior Care Partners |
$44.46
|
| Rate for Payer: PACE SWMI |
$46.80
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: PHP Medicare Advantage |
$46.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health HMO/PPO |
$162.86
|
| Rate for Payer: Priority Health Medicare |
$47.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.42
|
| Rate for Payer: Railroad Medicare Medicare |
$46.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.80
|
| Rate for Payer: UHC Exchange |
$46.80
|
| Rate for Payer: UHC Medicare Advantage |
$46.80
|
| Rate for Payer: VA VA |
$46.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna Medicare |
$71.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.12
|
| Rate for Payer: BCBS Complete |
$110.24
|
| Rate for Payer: BCBS MAPPO |
$68.90
|
| Rate for Payer: BCBS Trust/PPO |
$226.57
|
| Rate for Payer: BCN Commercial |
$214.28
|
| Rate for Payer: BCN Medicare Advantage |
$68.90
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.90
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: PACE Senior Care Partners |
$65.45
|
| Rate for Payer: PACE SWMI |
$68.90
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: PHP Medicare Advantage |
$68.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health HMO/PPO |
$239.77
|
| Rate for Payer: Priority Health Medicare |
$69.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.65
|
| Rate for Payer: Railroad Medicare Medicare |
$68.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.53
|
| Rate for Payer: UHC Core |
$230.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.90
|
| Rate for Payer: UHC Exchange |
$68.90
|
| Rate for Payer: UHC Medicare Advantage |
$68.90
|
| Rate for Payer: VA VA |
$68.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: BCBS Trust/PPO |
$152.81
|
| Rate for Payer: BCN Commercial |
$144.67
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: Nomi Health Commercial |
$153.50
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health HMO/PPO |
$162.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.74
|
| Rate for Payer: UHC Core |
$156.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$146.93
|
| Rate for Payer: BCN Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$46.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.25
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$147.98
|
| Rate for Payer: BCN Commercial |
$139.95
|
| Rate for Payer: BCN Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$147.60
|
| Rate for Payer: PACE Senior Care Partners |
$42.75
|
| Rate for Payer: PACE SWMI |
$45.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$45.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health HMO/PPO |
$156.60
|
| Rate for Payer: Priority Health Medicare |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.60
|
| Rate for Payer: Railroad Medicare Medicare |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.40
|
| Rate for Payer: UHC Core |
$150.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.00
|
| Rate for Payer: UHC Exchange |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
| Rate for Payer: VA VA |
$45.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
