|
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 |
$44.86 |
| 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 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 |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.39
|
|
|
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 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 Commercial |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.58
|
| 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: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.11
|
| 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 Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.32
|
| 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: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| 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 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 Commercial |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$94.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.58
|
| 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: PHP Commercial |
$92.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.11
|
| Rate for Payer: Priority Health SBD |
$68.92
|
| 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
|
$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: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.32
|
| 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 Commercial |
$15.32
|
| 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: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.41
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$196.45
|
|
|
Service Code
|
NDC 00406915076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.44 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna American Axle |
$127.69
|
| Rate for Payer: Aetna Commercial |
$166.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.69
|
| Rate for Payer: Cash Price |
$157.16
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Cofinity Commercial |
$168.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.16
|
| Rate for Payer: Healthscope Commercial |
$176.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.98
|
| Rate for Payer: PHP Commercial |
$166.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.69
|
| Rate for Payer: Priority Health SBD |
$123.76
|
| Rate for Payer: UMR Bronson Commercial |
$86.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.34
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$40.98
|
|
|
Service Code
|
NDC 47781042611
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna American Axle |
$26.64
|
| Rate for Payer: Aetna Commercial |
$34.83
|
| Rate for Payer: Aetna Medicare |
$20.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.64
|
| Rate for Payer: BCBS Complete |
$16.39
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$28.69
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$36.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.83
|
| Rate for Payer: PHP Commercial |
$34.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.64
|
| Rate for Payer: Priority Health SBD |
$25.82
|
| Rate for Payer: UMR Bronson Commercial |
$15.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$204.87
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.14 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Aetna American Axle |
$133.17
|
| Rate for Payer: Aetna Commercial |
$174.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.17
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cofinity Commercial |
$143.41
|
| Rate for Payer: Cofinity Commercial |
$176.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.90
|
| Rate for Payer: Healthscope Commercial |
$184.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.14
|
| Rate for Payer: PHP Commercial |
$174.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health SBD |
$129.07
|
| Rate for Payer: UMR Bronson Commercial |
$90.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.65
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$196.45
|
|
|
Service Code
|
NDC 00406915076
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.69 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna American Axle |
$127.69
|
| Rate for Payer: Aetna Commercial |
$166.98
|
| Rate for Payer: Aetna Medicare |
$98.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.69
|
| Rate for Payer: BCBS Complete |
$78.58
|
| Rate for Payer: Cash Price |
$157.16
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Cofinity Commercial |
$168.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.16
|
| Rate for Payer: Healthscope Commercial |
$176.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.98
|
| Rate for Payer: PHP Commercial |
$166.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.69
|
| Rate for Payer: Priority Health SBD |
$123.76
|
| Rate for Payer: UMR Bronson Commercial |
$72.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.34
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$204.87
|
|
|
Service Code
|
NDC 47781042647
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Aetna American Axle |
$133.17
|
| Rate for Payer: Aetna Commercial |
$174.14
|
| Rate for Payer: Aetna Medicare |
$102.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.17
|
| Rate for Payer: BCBS Complete |
$81.95
|
| Rate for Payer: Cash Price |
$163.90
|
| Rate for Payer: Cofinity Commercial |
$143.41
|
| Rate for Payer: Cofinity Commercial |
$176.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.90
|
| Rate for Payer: Healthscope Commercial |
$184.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.14
|
| Rate for Payer: PHP Commercial |
$174.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.17
|
| Rate for Payer: Priority Health SBD |
$129.07
|
| Rate for Payer: UMR Bronson Commercial |
$75.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.65
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$40.98
|
|
|
Service Code
|
NDC 47781042611
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna American Axle |
$26.64
|
| Rate for Payer: Aetna Commercial |
$34.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.64
|
| Rate for Payer: Cash Price |
$32.78
|
| Rate for Payer: Cofinity Commercial |
$28.69
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$36.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.83
|
| Rate for Payer: PHP Commercial |
$34.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.64
|
| Rate for Payer: Priority Health SBD |
$25.82
|
| Rate for Payer: UMR Bronson Commercial |
$18.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.74
|
|
|
FENTANYL 50 MCG/ML 2ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$22.04
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
180136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna American Axle |
$14.33
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$9.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.53
|
|
|
FENTANYL 50 MCG/ML 2ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$22.04
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
180136
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: Aetna American Axle |
$14.33
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$11.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$15.43
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$8.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.53
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
IP
|
$14.39
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna American Axle |
$9.35
|
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: UMR Bronson Commercial |
$6.33
|
| Rate for Payer: UMR Bronson Commercial |
$9.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
|
|
FENTANYL 50 MCG/ML INHALATION
|
Facility
|
OP
|
$20.98
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
300141
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$18.88 |
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$14.69
|
| Rate for Payer: Cofinity Commercial |
$18.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.29
|
| Rate for Payer: Aetna American Axle |
$13.64
|
| Rate for Payer: Aetna American Axle |
$11.41
|
| Rate for Payer: Aetna American Axle |
$9.35
|
| Rate for Payer: Aetna Commercial |
$17.83
|
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Commercial |
$14.93
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: Aetna Medicare |
$7.20
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.41
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$8.39
|
| Rate for Payer: BCBS Complete |
$5.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$14.05
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$16.78
|
| Rate for Payer: Cofinity Commercial |
$15.10
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.78
|
| Rate for Payer: Healthscope Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$12.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$17.83
|
| Rate for Payer: PHP Commercial |
$12.23
|
| Rate for Payer: PHP Commercial |
$14.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.64
|
| Rate for Payer: Priority Health SBD |
$11.06
|
| Rate for Payer: Priority Health SBD |
$13.22
|
| Rate for Payer: Priority Health SBD |
$9.07
|
| Rate for Payer: UMR Bronson Commercial |
$7.76
|
| Rate for Payer: UMR Bronson Commercial |
$5.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.74
|
|
|
FENTANYL BOLUS FROM BAG 10 MCG/ML
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
500621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
|
|
FENTANYL BOLUS FROM BAG 50 MCG/ML
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
169200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
|
|
FENTANYL BOLUS FROM BAG 5 MCG/ML
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
169201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
|
|
FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$125.16
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
30807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.07 |
| Max. Negotiated Rate |
$112.64 |
| Rate for Payer: Aetna American Axle |
$81.35
|
| Rate for Payer: Aetna Commercial |
$106.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.35
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$87.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.39
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.35
|
| Rate for Payer: Priority Health SBD |
$78.85
|
| Rate for Payer: UMR Bronson Commercial |
$55.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.87
|
|
|
FENTANYL (PF) 10 MCG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$125.16
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
30807
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$112.64 |
| Rate for Payer: Aetna American Axle |
$81.35
|
| Rate for Payer: Aetna Commercial |
$106.39
|
| Rate for Payer: Aetna Medicare |
$62.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.35
|
| Rate for Payer: BCBS Complete |
$50.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cash Price |
$100.13
|
| Rate for Payer: Cofinity Commercial |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$87.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.13
|
| Rate for Payer: Healthscope Commercial |
$112.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.39
|
| Rate for Payer: PHP Commercial |
$106.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.35
|
| Rate for Payer: Priority Health SBD |
$78.85
|
| Rate for Payer: UMR Bronson Commercial |
$46.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.87
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
OP
|
$86.78
|
|
|
Service Code
|
NDC 09900001023
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.11 |
| Max. Negotiated Rate |
$78.10 |
| Rate for Payer: Aetna American Axle |
$56.41
|
| Rate for Payer: Aetna Commercial |
$73.76
|
| Rate for Payer: Aetna Medicare |
$43.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.41
|
| Rate for Payer: BCBS Complete |
$34.71
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: Cofinity Commercial |
$60.75
|
| Rate for Payer: Cofinity Commercial |
$74.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.42
|
| Rate for Payer: Healthscope Commercial |
$78.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.76
|
| Rate for Payer: PHP Commercial |
$73.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$54.67
|
| Rate for Payer: UMR Bronson Commercial |
$32.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.08
|
|
|
FENTANYL (PF) 2 MCG/ML-BUPIVACAINE 0.1 %-NACL INJECTION SOLUTION
|
Facility
|
IP
|
$86.78
|
|
|
Service Code
|
NDC 09900001023
|
| Hospital Charge Code |
30863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.18 |
| Max. Negotiated Rate |
$78.10 |
| Rate for Payer: Aetna American Axle |
$56.41
|
| Rate for Payer: Aetna Commercial |
$73.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.41
|
| Rate for Payer: Cash Price |
$69.42
|
| Rate for Payer: Cofinity Commercial |
$60.75
|
| Rate for Payer: Cofinity Commercial |
$74.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.42
|
| Rate for Payer: Healthscope Commercial |
$78.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.76
|
| Rate for Payer: PHP Commercial |
$73.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.41
|
| Rate for Payer: Priority Health SBD |
$54.67
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.08
|
|
|
FENTANYL (PF) 4 MCG/ML SD (NICU)
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
165999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna Medicare |
$0.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
|
FENTANYL (PF) 4 MCG/ML SD (NICU)
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
165999
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.19
|
|
