|
FELBAMATE 600 MG TABLET
|
Facility
|
IP
|
$5,796.79
|
|
|
Service Code
|
NDC 0037-0431-01
|
| Hospital Charge Code |
10025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,550.59 |
| Max. Negotiated Rate |
$5,217.11 |
| Rate for Payer: Aetna American Axle |
$3,767.91
|
| Rate for Payer: Aetna Commercial |
$4,927.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,767.91
|
| Rate for Payer: Cash Price |
$4,637.43
|
| Rate for Payer: Cofinity Commercial |
$4,057.75
|
| Rate for Payer: Cofinity Commercial |
$4,985.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,637.43
|
| Rate for Payer: Healthscope Commercial |
$5,217.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,057.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,347.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,927.27
|
| Rate for Payer: PHP Commercial |
$4,927.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,057.75
|
| Rate for Payer: Priority Health SBD |
$3,651.98
|
| Rate for Payer: UMR Bronson Commercial |
$2,550.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,347.59
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$37,427.13
|
|
|
Service Code
|
MS-DRG 748
|
| Min. Negotiated Rate |
$10,771.63 |
| Max. Negotiated Rate |
$37,427.13 |
| Rate for Payer: Aetna Medicare |
$11,792.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,173.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,173.20
|
| Rate for Payer: BCBS MAPPO |
$11,338.56
|
| Rate for Payer: BCBS Trust/PPO |
$37,427.13
|
| Rate for Payer: BCN Medicare Advantage |
$11,338.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,338.56
|
| Rate for Payer: Mclaren Medicare |
$11,338.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,905.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,039.34
|
| Rate for Payer: PACE Medicare |
$10,771.63
|
| Rate for Payer: PACE SWMI |
$11,338.56
|
| Rate for Payer: PHP Medicare Advantage |
$11,338.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,160.20
|
| Rate for Payer: Priority Health Medicare |
$11,338.56
|
| Rate for Payer: Priority Health Narrow Network |
$16,128.16
|
| Rate for Payer: Railroad Medicare Medicare |
$11,338.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,430.34
|
| Rate for Payer: UHC Core |
$17,572.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,338.56
|
| Rate for Payer: UHC Exchange |
$13,970.33
|
| Rate for Payer: UHC Medicare Advantage |
$11,678.72
|
| Rate for Payer: VA VA |
$11,338.56
|
|
|
FENOFIBRATE 160 MG TABLET
|
Facility
|
IP
|
$763.78
|
|
|
Service Code
|
NDC 0378-7101-77
|
| Hospital Charge Code |
28252
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.06 |
| Max. Negotiated Rate |
$687.40 |
| Rate for Payer: Aetna American Axle |
$496.46
|
| Rate for Payer: Aetna Commercial |
$649.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.46
|
| Rate for Payer: Cash Price |
$611.02
|
| Rate for Payer: Cofinity Commercial |
$534.65
|
| Rate for Payer: Cofinity Commercial |
$656.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$611.02
|
| Rate for Payer: Healthscope Commercial |
$687.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$534.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$572.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$649.21
|
| Rate for Payer: PHP Commercial |
$649.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.65
|
| Rate for Payer: Priority Health SBD |
$481.18
|
| Rate for Payer: UMR Bronson Commercial |
$336.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$572.84
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$835.83
|
|
|
Service Code
|
NDC 0904-7161-61
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Aetna American Axle |
$543.29
|
| Rate for Payer: Aetna Commercial |
$710.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.29
|
| Rate for Payer: Cash Price |
$668.66
|
| Rate for Payer: Cofinity Commercial |
$585.08
|
| Rate for Payer: Cofinity Commercial |
$718.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$668.66
|
| Rate for Payer: Healthscope Commercial |
$752.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$585.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$626.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$710.46
|
| Rate for Payer: PHP Commercial |
$710.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.08
|
| Rate for Payer: Priority Health SBD |
$526.57
|
| Rate for Payer: UMR Bronson Commercial |
$367.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$626.87
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$952.75
|
|
|
Service Code
|
NDC 51079-608-20
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$419.21 |
| Max. Negotiated Rate |
$857.48 |
| Rate for Payer: Aetna American Axle |
$619.29
|
| Rate for Payer: Aetna Commercial |
$809.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.29
|
| Rate for Payer: Cash Price |
$762.20
|
| Rate for Payer: Cofinity Commercial |
$666.92
|
| Rate for Payer: Cofinity Commercial |
$819.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$762.20
|
| Rate for Payer: Healthscope Commercial |
$857.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$666.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$714.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$809.84
|
| Rate for Payer: PHP Commercial |
$809.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.92
|
| Rate for Payer: Priority Health SBD |
$600.23
|
| Rate for Payer: UMR Bronson Commercial |
$419.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.56
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$171.86
|
|
|
Service Code
|
NDC 69097-458-05
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.62 |
| Max. Negotiated Rate |
$154.67 |
| Rate for Payer: Aetna American Axle |
$111.71
|
| Rate for Payer: Aetna Commercial |
$146.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.71
|
| Rate for Payer: Cash Price |
$137.49
|
| Rate for Payer: Cofinity Commercial |
$120.30
|
| Rate for Payer: Cofinity Commercial |
$147.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.49
|
| Rate for Payer: Healthscope Commercial |
$154.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.08
|
| Rate for Payer: PHP Commercial |
$146.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.30
|
| Rate for Payer: Priority Health SBD |
$108.27
|
| Rate for Payer: UMR Bronson Commercial |
$75.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.90
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$176.99
|
|
|
Service Code
|
NDC 68180-389-09
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna American Axle |
$115.04
|
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.59
|
| Rate for Payer: Healthscope Commercial |
$159.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.44
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.89
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: UMR Bronson Commercial |
$77.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
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 |
$47.59 |
| Max. Negotiated Rate |
$97.34 |
| Rate for Payer: Aetna American Axle |
$70.30
|
| Rate for Payer: Aetna Commercial |
$91.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.30
|
| Rate for Payer: Cash Price |
$86.52
|
| Rate for Payer: Cofinity Commercial |
$75.70
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$75.70
|
| 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 SBD |
$68.13
|
| Rate for Payer: UMR Bronson Commercial |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.11
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$460.80
|
|
|
Service Code
|
NDC 51079-599-20
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.75 |
| Max. Negotiated Rate |
$414.72 |
| Rate for Payer: Aetna American Axle |
$299.52
|
| Rate for Payer: Aetna Commercial |
$391.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.52
|
| Rate for Payer: Cash Price |
$368.64
|
| Rate for Payer: Cofinity Commercial |
$322.56
|
| Rate for Payer: Cofinity Commercial |
$396.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.64
|
| Rate for Payer: Healthscope Commercial |
$414.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$322.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$345.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$391.68
|
| Rate for Payer: PHP Commercial |
$391.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.56
|
| Rate for Payer: Priority Health SBD |
$290.30
|
| Rate for Payer: UMR Bronson Commercial |
$202.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$345.60
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 51079-599-01
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.92
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.23
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
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 |
$1.59 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna American Axle |
$2.35
|
| Rate for Payer: Aetna Commercial |
$3.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.53
|
| 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 SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.71
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$143.29
|
|
|
Service Code
|
NDC 60505-7009-2
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$128.96 |
| Rate for Payer: Aetna American Axle |
$93.14
|
| Rate for Payer: Aetna Commercial |
$121.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.14
|
| Rate for Payer: Cash Price |
$114.63
|
| Rate for Payer: Cofinity Commercial |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.63
|
| Rate for Payer: Healthscope Commercial |
$128.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.80
|
| Rate for Payer: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.30
|
| Rate for Payer: Priority Health SBD |
$90.27
|
| Rate for Payer: UMR Bronson Commercial |
$63.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.47
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$28.66
|
|
|
Service Code
|
NDC 60505-7009-0
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna American Axle |
$18.63
|
| Rate for Payer: Aetna Commercial |
$24.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.63
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Commercial |
$24.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.93
|
| Rate for Payer: Healthscope Commercial |
$25.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.36
|
| Rate for Payer: PHP Commercial |
$24.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.06
|
| Rate for Payer: Priority Health SBD |
$18.06
|
| Rate for Payer: UMR Bronson Commercial |
$12.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.50
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$31.40
|
|
|
Service Code
|
NDC 47781-428-11
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$28.26 |
| Rate for Payer: Aetna American Axle |
$20.41
|
| Rate for Payer: Aetna Commercial |
$26.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.41
|
| Rate for Payer: Cash Price |
$25.12
|
| Rate for Payer: Cofinity Commercial |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$27.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.12
|
| Rate for Payer: Healthscope Commercial |
$28.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.69
|
| Rate for Payer: PHP Commercial |
$26.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.98
|
| Rate for Payer: Priority Health SBD |
$19.78
|
| Rate for Payer: UMR Bronson Commercial |
$13.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.55
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$156.99
|
|
|
Service Code
|
NDC 47781-428-47
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.08 |
| Max. Negotiated Rate |
$141.29 |
| Rate for Payer: Aetna American Axle |
$102.04
|
| Rate for Payer: Aetna Commercial |
$133.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.04
|
| Rate for Payer: Cash Price |
$125.59
|
| Rate for Payer: Cofinity Commercial |
$109.89
|
| Rate for Payer: Cofinity Commercial |
$135.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.59
|
| Rate for Payer: Healthscope Commercial |
$141.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.44
|
| Rate for Payer: PHP Commercial |
$133.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.89
|
| Rate for Payer: Priority Health SBD |
$98.90
|
| Rate for Payer: UMR Bronson Commercial |
$69.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.74
|
|
|
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 |
$67.42 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna American Axle |
$99.59
|
| Rate for Payer: Aetna Commercial |
$130.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.59
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.25
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$107.25
|
| 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 SBD |
$96.53
|
| Rate for Payer: UMR Bronson Commercial |
$67.42
|
| 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 |
$67.42 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna American Axle |
$99.59
|
| Rate for Payer: Aetna Commercial |
$130.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.59
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cofinity Commercial |
$107.25
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$107.25
|
| 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 SBD |
$96.53
|
| Rate for Payer: UMR Bronson Commercial |
$67.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.92
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$61.47
|
|
|
Service Code
|
NDC 47781-424-47
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$55.32 |
| Rate for Payer: Aetna American Axle |
$39.96
|
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.96
|
| Rate for Payer: Cash Price |
$49.18
|
| Rate for Payer: Cofinity Commercial |
$43.03
|
| Rate for Payer: Cofinity Commercial |
$52.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.18
|
| Rate for Payer: Healthscope Commercial |
$55.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.25
|
| Rate for Payer: PHP Commercial |
$52.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.03
|
| Rate for Payer: Priority Health SBD |
$38.73
|
| Rate for Payer: UMR Bronson Commercial |
$27.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.10
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$12.30
|
|
|
Service Code
|
NDC 47781-424-11
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.41 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Aetna American Axle |
$8.00
|
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.00
|
| Rate for Payer: Cash Price |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$11.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.46
|
| Rate for Payer: PHP Commercial |
$10.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.61
|
| Rate for Payer: Priority Health SBD |
$7.75
|
| Rate for Payer: UMR Bronson Commercial |
$5.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.22
|
|
|
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 |
$20.54 |
| Max. Negotiated Rate |
$42.02 |
| Rate for Payer: Aetna American Axle |
$30.35
|
| Rate for Payer: Aetna Commercial |
$39.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$32.68
|
| 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 SBD |
$29.41
|
| Rate for Payer: UMR Bronson Commercial |
$20.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.02
|
|
|
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 |
$4.11 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Aetna American Axle |
$6.07
|
| Rate for Payer: Aetna Commercial |
$7.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.07
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$6.54
|
| 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 SBD |
$5.88
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.00
|
|
|
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 |
$6.89 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Aetna American Axle |
$10.17
|
| Rate for Payer: Aetna Commercial |
$13.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.17
|
| Rate for Payer: Cash Price |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$10.96
|
| 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 SBD |
$9.86
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$22.70
|
|
|
Service Code
|
NDC 47781-426-11
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.99 |
| Max. Negotiated Rate |
$20.43 |
| Rate for Payer: Aetna American Axle |
$14.76
|
| Rate for Payer: Aetna Commercial |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.76
|
| Rate for Payer: Cash Price |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$15.89
|
| Rate for Payer: Cofinity Commercial |
$19.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.16
|
| Rate for Payer: Healthscope Commercial |
$20.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.30
|
| Rate for Payer: PHP Commercial |
$19.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health SBD |
$14.30
|
| Rate for Payer: UMR Bronson Commercial |
$9.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.02
|
|
|
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 |
$34.43 |
| Max. Negotiated Rate |
$70.42 |
| Rate for Payer: Aetna American Axle |
$50.86
|
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.86
|
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Cofinity Commercial |
$54.77
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$54.77
|
| 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 SBD |
$49.29
|
| Rate for Payer: UMR Bronson Commercial |
$34.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.68
|
|
|
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 |
$49.94 |
| Max. Negotiated Rate |
$102.14 |
| Rate for Payer: Aetna American Axle |
$73.77
|
| Rate for Payer: Aetna Commercial |
$96.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.77
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cofinity Commercial |
$79.44
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$79.44
|
| 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 SBD |
$71.50
|
| Rate for Payer: UMR Bronson Commercial |
$49.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.12
|
|
