|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$422.87
|
|
|
Service Code
|
NDC 47781042847
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.46 |
| Max. Negotiated Rate |
$380.58 |
| Rate for Payer: Aetna American Axle |
$274.87
|
| Rate for Payer: Aetna Commercial |
$359.44
|
| Rate for Payer: Aetna Medicare |
$211.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.87
|
| Rate for Payer: BCBS Complete |
$169.15
|
| Rate for Payer: Cash Price |
$338.30
|
| Rate for Payer: Cofinity Advantage |
$296.01
|
| Rate for Payer: Cofinity Commercial |
$363.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.30
|
| Rate for Payer: Healthscope Commercial |
$380.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.15
|
| Rate for Payer: PHP Commercial |
$359.44
|
| Rate for Payer: Priority Health SBD |
$266.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.87
|
| Rate for Payer: UHC Core |
$220.32
|
| Rate for Payer: UHC Exchange |
$166.19
|
| Rate for Payer: UMR Bronson Commercial |
$156.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.15
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$422.87
|
|
|
Service Code
|
NDC 47781042847
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.06 |
| Max. Negotiated Rate |
$380.58 |
| Rate for Payer: Aetna American Axle |
$274.87
|
| Rate for Payer: Aetna Commercial |
$359.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.87
|
| Rate for Payer: Cash Price |
$338.30
|
| Rate for Payer: Cofinity Advantage |
$296.01
|
| Rate for Payer: Cofinity Commercial |
$363.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.30
|
| Rate for Payer: Healthscope Commercial |
$380.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.15
|
| Rate for Payer: PHP Commercial |
$359.44
|
| Rate for Payer: Priority Health SBD |
$266.41
|
| Rate for Payer: UMR Bronson Commercial |
$186.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.15
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$84.58
|
|
|
Service Code
|
NDC 47781042811
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$76.12 |
| Rate for Payer: Aetna American Axle |
$54.98
|
| Rate for Payer: Aetna Commercial |
$71.89
|
| Rate for Payer: Aetna Medicare |
$42.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.98
|
| Rate for Payer: BCBS Complete |
$33.83
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Advantage |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$72.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$76.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.44
|
| Rate for Payer: PHP Commercial |
$71.89
|
| Rate for Payer: Priority Health SBD |
$53.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.98
|
| Rate for Payer: UHC Core |
$44.07
|
| Rate for Payer: UHC Exchange |
$33.24
|
| Rate for Payer: UMR Bronson Commercial |
$31.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.44
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$84.58
|
|
|
Service Code
|
NDC 47781042811
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$76.12 |
| Rate for Payer: Aetna American Axle |
$54.98
|
| Rate for Payer: Aetna Commercial |
$71.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.98
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Advantage |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$72.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$76.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.44
|
| Rate for Payer: PHP Commercial |
$71.89
|
| Rate for Payer: Priority Health SBD |
$53.29
|
| Rate for Payer: UMR Bronson Commercial |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.44
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$249.25
|
|
|
Service Code
|
NDC 47781042347
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.22 |
| Max. Negotiated Rate |
$224.32 |
| Rate for Payer: Aetna American Axle |
$162.01
|
| Rate for Payer: Aetna Commercial |
$211.86
|
| Rate for Payer: Aetna Medicare |
$124.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.01
|
| Rate for Payer: BCBS Complete |
$99.70
|
| Rate for Payer: Cash Price |
$199.40
|
| Rate for Payer: Cofinity Advantage |
$174.47
|
| Rate for Payer: Cofinity Commercial |
$214.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.40
|
| Rate for Payer: Healthscope Commercial |
$224.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.94
|
| Rate for Payer: PHP Commercial |
$211.86
|
| Rate for Payer: Priority Health SBD |
$157.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.01
|
| Rate for Payer: UHC Core |
$129.86
|
| Rate for Payer: UHC Exchange |
$97.96
|
| Rate for Payer: UMR Bronson Commercial |
$92.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.94
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$263.71
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.03 |
| Max. Negotiated Rate |
$237.34 |
| Rate for Payer: Aetna American Axle |
$171.41
|
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.41
|
| Rate for Payer: Cash Price |
$210.97
|
| Rate for Payer: Cofinity Advantage |
$184.60
|
| Rate for Payer: Cofinity Commercial |
$226.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.97
|
| Rate for Payer: Healthscope Commercial |
$237.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.78
|
| Rate for Payer: PHP Commercial |
$224.15
|
| Rate for Payer: Priority Health SBD |
$166.14
|
| Rate for Payer: UMR Bronson Commercial |
$116.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.78
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$52.75
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.21 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Aetna American Axle |
$34.29
|
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.29
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cofinity Advantage |
$36.92
|
| Rate for Payer: Cofinity Commercial |
$45.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$47.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.56
|
| Rate for Payer: PHP Commercial |
$44.84
|
| Rate for Payer: Priority Health SBD |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$23.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.56
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$52.75
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$47.48 |
| Rate for Payer: Aetna American Axle |
$34.29
|
| Rate for Payer: Aetna Commercial |
$44.84
|
| Rate for Payer: Aetna Medicare |
$26.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.29
|
| Rate for Payer: BCBS Complete |
$21.10
|
| Rate for Payer: Cash Price |
$42.20
|
| Rate for Payer: Cofinity Advantage |
$36.92
|
| Rate for Payer: Cofinity Commercial |
$45.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.20
|
| Rate for Payer: Healthscope Commercial |
$47.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.56
|
| Rate for Payer: PHP Commercial |
$44.84
|
| Rate for Payer: Priority Health SBD |
$33.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.29
|
| Rate for Payer: UHC Core |
$27.48
|
| Rate for Payer: UHC Exchange |
$20.73
|
| Rate for Payer: UMR Bronson Commercial |
$19.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.56
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$263.71
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.57 |
| Max. Negotiated Rate |
$237.34 |
| Rate for Payer: Aetna American Axle |
$171.41
|
| Rate for Payer: Aetna Commercial |
$224.15
|
| Rate for Payer: Aetna Medicare |
$131.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.41
|
| Rate for Payer: BCBS Complete |
$105.48
|
| Rate for Payer: Cash Price |
$210.97
|
| Rate for Payer: Cofinity Advantage |
$184.60
|
| Rate for Payer: Cofinity Commercial |
$226.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.97
|
| Rate for Payer: Healthscope Commercial |
$237.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.78
|
| Rate for Payer: PHP Commercial |
$224.15
|
| Rate for Payer: Priority Health SBD |
$166.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.41
|
| Rate for Payer: UHC Core |
$137.39
|
| Rate for Payer: UHC Exchange |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$97.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.78
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$49.85
|
|
|
Service Code
|
NDC 47781042311
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna American Axle |
$32.40
|
| Rate for Payer: Aetna Commercial |
$42.37
|
| Rate for Payer: Aetna Medicare |
$24.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.40
|
| Rate for Payer: BCBS Complete |
$19.94
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cofinity Advantage |
$34.90
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.88
|
| Rate for Payer: Healthscope Commercial |
$44.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.39
|
| Rate for Payer: PHP Commercial |
$42.37
|
| Rate for Payer: Priority Health SBD |
$31.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.40
|
| Rate for Payer: UHC Core |
$25.97
|
| Rate for Payer: UHC Exchange |
$19.59
|
| Rate for Payer: UMR Bronson Commercial |
$18.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.39
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$49.85
|
|
|
Service Code
|
NDC 47781042311
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$44.87 |
| Rate for Payer: Aetna American Axle |
$32.40
|
| Rate for Payer: Aetna Commercial |
$42.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.40
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cofinity Advantage |
$34.90
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.88
|
| Rate for Payer: Healthscope Commercial |
$44.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.39
|
| Rate for Payer: PHP Commercial |
$42.37
|
| Rate for Payer: Priority Health SBD |
$31.41
|
| Rate for Payer: UMR Bronson Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.39
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$249.25
|
|
|
Service Code
|
NDC 47781042347
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$224.32 |
| Rate for Payer: Aetna American Axle |
$162.01
|
| Rate for Payer: Aetna Commercial |
$211.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.01
|
| Rate for Payer: Cash Price |
$199.40
|
| Rate for Payer: Cofinity Advantage |
$174.47
|
| Rate for Payer: Cofinity Commercial |
$214.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.40
|
| Rate for Payer: Healthscope Commercial |
$224.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.94
|
| Rate for Payer: PHP Commercial |
$211.86
|
| Rate for Payer: Priority Health SBD |
$157.03
|
| Rate for Payer: UMR Bronson Commercial |
$109.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.94
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$95.16
|
|
|
Service Code
|
NDC 50742055005
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Aetna American Axle |
$61.85
|
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.85
|
| Rate for Payer: Cash Price |
$76.13
|
| Rate for Payer: Cofinity Advantage |
$66.61
|
| Rate for Payer: Cofinity Commercial |
$81.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.13
|
| Rate for Payer: Healthscope Commercial |
$85.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.37
|
| Rate for Payer: PHP Commercial |
$80.89
|
| Rate for Payer: Priority Health SBD |
$59.95
|
| Rate for Payer: UMR Bronson Commercial |
$41.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.37
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$109.40
|
|
|
Service Code
|
NDC 47781042447
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna American Axle |
$71.11
|
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna Medicare |
$54.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.11
|
| Rate for Payer: BCBS Complete |
$43.76
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Advantage |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health SBD |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.11
|
| Rate for Payer: UHC Core |
$57.00
|
| Rate for Payer: UHC Exchange |
$42.99
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.05
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$95.16
|
|
|
Service Code
|
NDC 50742055005
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.21 |
| Max. Negotiated Rate |
$85.64 |
| Rate for Payer: Aetna American Axle |
$61.85
|
| Rate for Payer: Aetna Commercial |
$80.89
|
| Rate for Payer: Aetna Medicare |
$47.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.85
|
| Rate for Payer: BCBS Complete |
$38.06
|
| Rate for Payer: Cash Price |
$76.13
|
| Rate for Payer: Cofinity Advantage |
$66.61
|
| Rate for Payer: Cofinity Commercial |
$81.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.13
|
| Rate for Payer: Healthscope Commercial |
$85.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.37
|
| Rate for Payer: PHP Commercial |
$80.89
|
| Rate for Payer: Priority Health SBD |
$59.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.85
|
| Rate for Payer: UHC Core |
$49.58
|
| Rate for Payer: UHC Exchange |
$37.40
|
| Rate for Payer: UMR Bronson Commercial |
$35.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.37
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$19.04
|
|
|
Service Code
|
NDC 50742055001
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Advantage |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$19.04
|
|
|
Service Code
|
NDC 50742055001
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.18
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: Cash Price |
$15.23
|
| Rate for Payer: Cofinity Advantage |
$13.33
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.28
|
| Rate for Payer: PHP Commercial |
$16.18
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$9.92
|
| Rate for Payer: UHC Exchange |
$7.48
|
| Rate for Payer: UMR Bronson Commercial |
$7.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.28
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$21.88
|
|
|
Service Code
|
NDC 47781042411
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.41
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.22
|
| Rate for Payer: UHC Core |
$11.40
|
| Rate for Payer: UHC Exchange |
$8.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.41
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$109.40
|
|
|
Service Code
|
NDC 00406912576
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna American Axle |
$71.11
|
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.11
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Advantage |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health SBD |
$68.92
|
| Rate for Payer: UMR Bronson Commercial |
$48.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.05
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$109.40
|
|
|
Service Code
|
NDC 00406912576
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna American Axle |
$71.11
|
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna Medicare |
$54.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.11
|
| Rate for Payer: BCBS Complete |
$43.76
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Advantage |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health SBD |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.11
|
| Rate for Payer: UHC Core |
$57.00
|
| Rate for Payer: UHC Exchange |
$42.99
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.05
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$109.40
|
|
|
Service Code
|
NDC 47781042447
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$98.46 |
| Rate for Payer: Aetna American Axle |
$71.11
|
| Rate for Payer: Aetna Commercial |
$92.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.11
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Advantage |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$98.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health SBD |
$68.92
|
| Rate for Payer: UMR Bronson Commercial |
$48.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.05
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$21.88
|
|
|
Service Code
|
NDC 47781042411
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Advantage |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.41
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$9.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.41
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$134.25
|
|
|
Service Code
|
NDC 50742055205
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.07 |
| Max. Negotiated Rate |
$120.83 |
| Rate for Payer: Aetna American Axle |
$87.26
|
| Rate for Payer: Aetna Commercial |
$114.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.26
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cofinity Advantage |
$93.97
|
| Rate for Payer: Cofinity Commercial |
$115.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.40
|
| Rate for Payer: Healthscope Commercial |
$120.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.69
|
| Rate for Payer: PHP Commercial |
$114.11
|
| Rate for Payer: Priority Health SBD |
$84.58
|
| Rate for Payer: UMR Bronson Commercial |
$59.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.69
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$26.85
|
|
|
Service Code
|
NDC 50742055201
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna American Axle |
$17.45
|
| Rate for Payer: Aetna Commercial |
$22.82
|
| Rate for Payer: Aetna Medicare |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.45
|
| Rate for Payer: BCBS Complete |
$10.74
|
| Rate for Payer: Cash Price |
$21.48
|
| Rate for Payer: Cofinity Advantage |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.48
|
| Rate for Payer: Healthscope Commercial |
$24.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.14
|
| Rate for Payer: PHP Commercial |
$22.82
|
| Rate for Payer: Priority Health SBD |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.45
|
| Rate for Payer: UHC Core |
$13.99
|
| Rate for Payer: UHC Exchange |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.14
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$194.37
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.52 |
| Max. Negotiated Rate |
$174.93 |
| Rate for Payer: Aetna American Axle |
$126.34
|
| Rate for Payer: Aetna Commercial |
$165.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.34
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cofinity Advantage |
$136.06
|
| Rate for Payer: Cofinity Commercial |
$167.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$174.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.78
|
| Rate for Payer: PHP Commercial |
$165.21
|
| Rate for Payer: Priority Health SBD |
$122.45
|
| Rate for Payer: UMR Bronson Commercial |
$85.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.78
|
|
