|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
IP
|
$855.07
|
|
|
Service Code
|
NDC 00904716161
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.23 |
| Max. Negotiated Rate |
$769.56 |
| Rate for Payer: Aetna American Axle |
$555.80
|
| Rate for Payer: Aetna Commercial |
$726.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.80
|
| Rate for Payer: Cash Price |
$684.06
|
| Rate for Payer: Cofinity Commercial |
$598.55
|
| Rate for Payer: Cofinity Commercial |
$735.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$598.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.06
|
| Rate for Payer: Healthscope Commercial |
$769.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$598.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$641.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$726.81
|
| Rate for Payer: PHP Commercial |
$726.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$555.80
|
| Rate for Payer: Priority Health SBD |
$538.69
|
| Rate for Payer: UMR Bronson Commercial |
$376.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$641.30
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$952.75
|
|
|
Service Code
|
NDC 51079060820
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.52 |
| Max. Negotiated Rate |
$857.48 |
| Rate for Payer: Aetna American Axle |
$619.29
|
| Rate for Payer: Aetna Commercial |
$809.84
|
| Rate for Payer: Aetna Medicare |
$476.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.29
|
| Rate for Payer: BCBS Complete |
$381.10
|
| Rate for Payer: Cash Price |
$762.20
|
| Rate for Payer: Cofinity Commercial |
$666.92
|
| Rate for Payer: Cofinity Commercial |
$819.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$666.92
|
| 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 Commercial |
$809.84
|
| Rate for Payer: PHP Commercial |
$809.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.29
|
| Rate for Payer: Priority Health SBD |
$600.23
|
| Rate for Payer: UMR Bronson Commercial |
$352.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$714.56
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 145 MG TABLET
|
Facility
|
OP
|
$176.99
|
|
|
Service Code
|
NDC 68180038909
|
| Hospital Charge Code |
40010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.49 |
| Max. Negotiated Rate |
$159.29 |
| Rate for Payer: Aetna American Axle |
$115.04
|
| Rate for Payer: Aetna Commercial |
$150.44
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.04
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: Cash Price |
$141.59
|
| Rate for Payer: Cofinity Commercial |
$123.89
|
| Rate for Payer: Cofinity Commercial |
$152.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.89
|
| 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 Commercial |
$150.44
|
| Rate for Payer: PHP Commercial |
$150.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.04
|
| Rate for Payer: Priority Health SBD |
$111.50
|
| Rate for Payer: UMR Bronson Commercial |
$65.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.74
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.64
|
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.64
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health SBD |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$121.68
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$109.51 |
| Rate for Payer: Aetna American Axle |
$79.09
|
| Rate for Payer: Aetna Commercial |
$103.43
|
| Rate for Payer: Aetna Medicare |
$60.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.09
|
| Rate for Payer: BCBS Complete |
$48.67
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$85.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.34
|
| Rate for Payer: Healthscope Commercial |
$109.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.43
|
| Rate for Payer: PHP Commercial |
$103.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health SBD |
$76.66
|
| Rate for Payer: UMR Bronson Commercial |
$45.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.26
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 51079059901
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$2.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$458.88
|
|
|
Service Code
|
NDC 51079059920
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.91 |
| Max. Negotiated Rate |
$412.99 |
| Rate for Payer: Aetna American Axle |
$298.27
|
| Rate for Payer: Aetna Commercial |
$390.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.27
|
| Rate for Payer: Cash Price |
$367.10
|
| Rate for Payer: Cofinity Commercial |
$321.22
|
| Rate for Payer: Cofinity Commercial |
$394.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.10
|
| Rate for Payer: Healthscope Commercial |
$412.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.05
|
| Rate for Payer: PHP Commercial |
$390.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.27
|
| Rate for Payer: Priority Health SBD |
$289.09
|
| Rate for Payer: UMR Bronson Commercial |
$201.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.16
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$4.06
|
|
|
Service Code
|
NDC 60687061811
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.64
|
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna Medicare |
$2.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.64
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.45
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.64
|
| Rate for Payer: Priority Health SBD |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$458.88
|
|
|
Service Code
|
NDC 51079059920
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.79 |
| Max. Negotiated Rate |
$412.99 |
| Rate for Payer: Aetna American Axle |
$298.27
|
| Rate for Payer: Aetna Commercial |
$390.05
|
| Rate for Payer: Aetna Medicare |
$229.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.27
|
| Rate for Payer: BCBS Complete |
$183.55
|
| Rate for Payer: Cash Price |
$367.10
|
| Rate for Payer: Cofinity Commercial |
$321.22
|
| Rate for Payer: Cofinity Commercial |
$394.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$321.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$367.10
|
| Rate for Payer: Healthscope Commercial |
$412.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$321.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$344.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.05
|
| Rate for Payer: PHP Commercial |
$390.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.27
|
| Rate for Payer: Priority Health SBD |
$289.09
|
| Rate for Payer: UMR Bronson Commercial |
$169.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$344.16
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 51079059901
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna American Axle |
$2.98
|
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.98
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health SBD |
$2.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$121.68
|
|
|
Service Code
|
NDC 60687061821
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.54 |
| Max. Negotiated Rate |
$109.51 |
| Rate for Payer: Aetna American Axle |
$79.09
|
| Rate for Payer: Aetna Commercial |
$103.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.09
|
| Rate for Payer: Cash Price |
$97.34
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$85.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.34
|
| Rate for Payer: Healthscope Commercial |
$109.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.43
|
| Rate for Payer: PHP Commercial |
$103.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health SBD |
$76.66
|
| Rate for Payer: UMR Bronson Commercial |
$53.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.26
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$28.66
|
|
|
Service Code
|
NDC 60505700900
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Cofinity Commercial |
$24.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.06
|
| Rate for Payer: Aetna American Axle |
$18.63
|
| Rate for Payer: Aetna Commercial |
$24.36
|
| Rate for Payer: Aetna Medicare |
$14.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.63
|
| Rate for Payer: BCBS Complete |
$11.46
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| 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 Commercial |
$24.36
|
| Rate for Payer: PHP Commercial |
$24.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.63
|
| Rate for Payer: Priority Health SBD |
$18.06
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.50
|
|
|
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 Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$72.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.21
|
| 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: PHP Commercial |
$71.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.98
|
| Rate for Payer: Priority Health SBD |
$53.29
|
| 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
|
OP
|
$143.29
|
|
|
Service Code
|
NDC 60505700902
|
| Hospital Charge Code |
27908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.02 |
| Max. Negotiated Rate |
$128.96 |
| Rate for Payer: Aetna American Axle |
$93.14
|
| Rate for Payer: Aetna Commercial |
$121.80
|
| Rate for Payer: Aetna Medicare |
$71.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.14
|
| Rate for Payer: BCBS Complete |
$57.32
|
| Rate for Payer: Cash Price |
$114.63
|
| Rate for Payer: Cofinity Commercial |
$100.30
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.30
|
| 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 Commercial |
$121.80
|
| Rate for Payer: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| Rate for Payer: Priority Health SBD |
$90.27
|
| Rate for Payer: UMR Bronson Commercial |
$53.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.47
|
|
|
FENTANYL 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$28.66
|
|
|
Service Code
|
NDC 60505700900
|
| 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: Cofinity Medicare Advantage |
$20.06
|
| 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 Commercial |
$24.36
|
| Rate for Payer: PHP Commercial |
$24.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.63
|
| 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
|
$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: PHP Commercial |
$71.89
|
| 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 Commercial |
$59.21
|
| Rate for Payer: Cofinity Commercial |
$72.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.21
|
| 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: Priority Health Cigna Priority Health |
$54.98
|
| 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 100 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$143.29
|
|
|
Service Code
|
NDC 60505700902
|
| 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: Cofinity Medicare Advantage |
$100.30
|
| 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 Commercial |
$121.80
|
| Rate for Payer: PHP Commercial |
$121.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.14
|
| 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
|
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 Commercial |
$296.01
|
| Rate for Payer: Cofinity Commercial |
$363.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.01
|
| 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: PHP Commercial |
$359.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.87
|
| Rate for Payer: Priority Health SBD |
$266.41
|
| 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 Commercial |
$296.01
|
| Rate for Payer: Cofinity Commercial |
$363.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.01
|
| 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: PHP Commercial |
$359.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.87
|
| 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 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 |
$44.86 |
| Rate for Payer: Aetna American Axle |
$32.40
|
| Rate for Payer: Aetna Commercial |
$42.37
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| 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 Commercial |
$34.90
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.88
|
| Rate for Payer: Healthscope Commercial |
$44.86
|
| 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: PHP Commercial |
$42.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.40
|
| Rate for Payer: Priority Health SBD |
$31.41
|
| 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
|
OP
|
$52.44
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna American Axle |
$34.09
|
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: Aetna Medicare |
$26.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.09
|
| Rate for Payer: BCBS Complete |
$20.98
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$36.71
|
| Rate for Payer: Cofinity Commercial |
$45.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$47.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: PHP Commercial |
$44.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health SBD |
$33.04
|
| Rate for Payer: UMR Bronson Commercial |
$19.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.33
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$262.19
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$235.97 |
| Rate for Payer: Aetna American Axle |
$170.42
|
| Rate for Payer: Aetna Commercial |
$222.86
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.42
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.75
|
| Rate for Payer: Cofinity Commercial |
$183.53
|
| Rate for Payer: Cofinity Commercial |
$225.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.75
|
| Rate for Payer: Healthscope Commercial |
$235.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.86
|
| Rate for Payer: PHP Commercial |
$222.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.42
|
| Rate for Payer: Priority Health SBD |
$165.18
|
| Rate for Payer: UMR Bronson Commercial |
$97.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.64
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$52.44
|
|
|
Service Code
|
NDC 00378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna American Axle |
$34.09
|
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.09
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$36.71
|
| Rate for Payer: Cofinity Commercial |
$45.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$47.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: PHP Commercial |
$44.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health SBD |
$33.04
|
| Rate for Payer: UMR Bronson Commercial |
$23.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.33
|
|
|
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 Commercial |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$214.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.48
|
| 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 |
$174.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.86
|
| Rate for Payer: PHP Commercial |
$211.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.01
|
| 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 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 Commercial |
$174.48
|
| Rate for Payer: Cofinity Commercial |
$214.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.48
|
| 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 |
$174.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.86
|
| Rate for Payer: PHP Commercial |
$211.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.01
|
| Rate for Payer: Priority Health SBD |
$157.03
|
| Rate for Payer: UMR Bronson Commercial |
$92.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.94
|
|
