|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$28,509.06
|
|
|
Service Code
|
APR-DRG 5144
|
| Min. Negotiated Rate |
$25,775.60 |
| Max. Negotiated Rate |
$28,509.06 |
| Rate for Payer: BCBS Complete |
$28,509.06
|
| Rate for Payer: Mclaren Medicaid |
$27,151.49
|
| Rate for Payer: Meridian Medicaid |
$28,509.06
|
| Rate for Payer: PHP Medicaid |
$25,775.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,151.49
|
| Rate for Payer: UHC Medicaid |
$27,151.49
|
| Rate for Payer: UHCCP Medicaid |
$27,151.49
|
|
|
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES
|
Facility
|
IP
|
$11,473.92
|
|
|
Service Code
|
APR-DRG 5142
|
| Min. Negotiated Rate |
$10,373.80 |
| Max. Negotiated Rate |
$11,473.92 |
| Rate for Payer: BCBS Complete |
$11,473.92
|
| Rate for Payer: Mclaren Medicaid |
$10,927.55
|
| Rate for Payer: Meridian Medicaid |
$11,473.92
|
| Rate for Payer: PHP Medicaid |
$10,373.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,927.55
|
| Rate for Payer: UHC Medicaid |
$10,927.55
|
| Rate for Payer: UHCCP Medicaid |
$10,927.55
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.38 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$196.06
|
| Rate for Payer: ASR ASR |
$211.31
|
| Rate for Payer: BCBS Trust/PPO |
$178.89
|
| Rate for Payer: BCN Commercial |
$178.89
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$204.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$211.31
|
| Rate for Payer: Healthscope Whirlpool |
$217.84
|
| Rate for Payer: Mclaren Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.70
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$217.84 |
| Rate for Payer: Aetna Commercial |
$196.06
|
| Rate for Payer: Aetna Medicare |
$80.60
|
| Rate for Payer: ASR ASR |
$211.31
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: BCBS Trust/PPO |
$179.61
|
| Rate for Payer: BCN Commercial |
$179.61
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$204.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$211.31
|
| Rate for Payer: Healthscope Whirlpool |
$217.84
|
| Rate for Payer: Mclaren Commercial |
$196.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.88
|
| Rate for Payer: Priority Health Narrow Network |
$152.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.70
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$52.74
|
|
|
Service Code
|
NDC 378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.51 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: Aetna Medicare |
$19.51
|
| Rate for Payer: ASR ASR |
$51.16
|
| Rate for Payer: BCBS Complete |
$21.10
|
| Rate for Payer: BCBS Trust/PPO |
$43.48
|
| Rate for Payer: BCN Commercial |
$43.48
|
| Rate for Payer: Cash Price |
$42.19
|
| Rate for Payer: Cofinity Commercial |
$49.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.19
|
| Rate for Payer: Healthscope Commercial |
$51.16
|
| Rate for Payer: Healthscope Whirlpool |
$52.74
|
| Rate for Payer: Mclaren Commercial |
$47.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.83
|
| Rate for Payer: Nomi Health Commercial |
$43.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$46.21
|
| Rate for Payer: Priority Health Narrow Network |
$36.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.41
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$263.70
|
|
|
Service Code
|
NDC 378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.78 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna Commercial |
$237.33
|
| Rate for Payer: ASR ASR |
$255.79
|
| Rate for Payer: BCBS Trust/PPO |
$216.55
|
| Rate for Payer: BCN Commercial |
$216.55
|
| Rate for Payer: Cash Price |
$210.96
|
| Rate for Payer: Cofinity Commercial |
$247.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.96
|
| Rate for Payer: Healthscope Commercial |
$255.79
|
| Rate for Payer: Healthscope Whirlpool |
$263.70
|
| Rate for Payer: Mclaren Commercial |
$237.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.15
|
| Rate for Payer: Nomi Health Commercial |
$216.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.06
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$52.74
|
|
|
Service Code
|
NDC 378911916
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$52.74 |
| Rate for Payer: Aetna Commercial |
$47.47
|
| Rate for Payer: ASR ASR |
$51.16
|
| Rate for Payer: BCBS Trust/PPO |
$43.31
|
| Rate for Payer: BCN Commercial |
$43.31
|
| Rate for Payer: Cash Price |
$42.19
|
| Rate for Payer: Cofinity Commercial |
$49.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.19
|
| Rate for Payer: Healthscope Commercial |
$51.16
|
| Rate for Payer: Healthscope Whirlpool |
$52.74
|
| Rate for Payer: Mclaren Commercial |
$47.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.83
|
| Rate for Payer: Nomi Health Commercial |
$43.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.41
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$263.70
|
|
|
Service Code
|
NDC 378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.57 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Aetna Commercial |
$237.33
|
| Rate for Payer: Aetna Medicare |
$97.57
|
| Rate for Payer: ASR ASR |
$255.79
|
| Rate for Payer: BCBS Complete |
$105.48
|
| Rate for Payer: BCBS Trust/PPO |
$217.42
|
| Rate for Payer: BCN Commercial |
$217.42
|
| Rate for Payer: Cash Price |
$210.96
|
| Rate for Payer: Cofinity Commercial |
$247.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.96
|
| Rate for Payer: Healthscope Commercial |
$255.79
|
| Rate for Payer: Healthscope Whirlpool |
$263.70
|
| Rate for Payer: Mclaren Commercial |
$237.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.15
|
| Rate for Payer: Nomi Health Commercial |
$216.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.06
|
| Rate for Payer: Priority Health Narrow Network |
$184.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.06
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$21.88
|
|
|
Service Code
|
NDC 378912116
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$19.69
|
| Rate for Payer: ASR ASR |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Commercial |
$17.97
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$21.88
|
| Rate for Payer: Mclaren Commercial |
$19.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: Nomi Health Commercial |
$17.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$109.40
|
|
|
Service Code
|
NDC 378912198
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$109.39 |
| Rate for Payer: Aetna Commercial |
$98.46
|
| Rate for Payer: Aetna Medicare |
$40.48
|
| Rate for Payer: ASR ASR |
$106.11
|
| Rate for Payer: BCBS Complete |
$43.76
|
| Rate for Payer: BCBS Trust/PPO |
$90.20
|
| Rate for Payer: BCN Commercial |
$90.20
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Commercial |
$102.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Healthscope Whirlpool |
$109.39
|
| Rate for Payer: Mclaren Commercial |
$98.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Nomi Health Commercial |
$89.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.85
|
| Rate for Payer: Priority Health Narrow Network |
$76.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.27
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$21.88
|
|
|
Service Code
|
NDC 378912116
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$21.88 |
| Rate for Payer: Aetna Commercial |
$19.69
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: ASR ASR |
$21.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$18.04
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$21.22
|
| Rate for Payer: Healthscope Whirlpool |
$21.88
|
| Rate for Payer: Mclaren Commercial |
$19.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: Nomi Health Commercial |
$17.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.17
|
| Rate for Payer: Priority Health Narrow Network |
$15.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$109.40
|
|
|
Service Code
|
NDC 378912198
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$109.39 |
| Rate for Payer: Aetna Commercial |
$98.46
|
| Rate for Payer: ASR ASR |
$106.11
|
| Rate for Payer: BCBS Trust/PPO |
$89.84
|
| Rate for Payer: BCN Commercial |
$89.84
|
| Rate for Payer: Cash Price |
$87.52
|
| Rate for Payer: Cofinity Commercial |
$102.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.52
|
| Rate for Payer: Healthscope Commercial |
$106.11
|
| Rate for Payer: Healthscope Whirlpool |
$109.39
|
| Rate for Payer: Mclaren Commercial |
$98.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.99
|
| Rate for Payer: Nomi Health Commercial |
$89.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.27
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$194.37
|
|
|
Service Code
|
NDC 378912298
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$194.37 |
| Rate for Payer: Aetna Commercial |
$174.93
|
| Rate for Payer: ASR ASR |
$188.54
|
| Rate for Payer: BCBS Trust/PPO |
$159.62
|
| Rate for Payer: BCN Commercial |
$159.62
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$188.54
|
| Rate for Payer: Healthscope Whirlpool |
$194.37
|
| Rate for Payer: Mclaren Commercial |
$174.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.21
|
| Rate for Payer: Nomi Health Commercial |
$159.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.05
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$38.87
|
|
|
Service Code
|
NDC 378912216
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$34.99
|
| Rate for Payer: Aetna Medicare |
$14.38
|
| Rate for Payer: ASR ASR |
$37.71
|
| Rate for Payer: BCBS Complete |
$15.55
|
| Rate for Payer: BCBS Trust/PPO |
$32.05
|
| Rate for Payer: BCN Commercial |
$32.05
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.10
|
| Rate for Payer: Healthscope Commercial |
$37.71
|
| Rate for Payer: Healthscope Whirlpool |
$38.87
|
| Rate for Payer: Mclaren Commercial |
$34.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.04
|
| Rate for Payer: Nomi Health Commercial |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.06
|
| Rate for Payer: Priority Health Narrow Network |
$27.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.21
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$194.37
|
|
|
Service Code
|
NDC 378912298
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.92 |
| Max. Negotiated Rate |
$194.37 |
| Rate for Payer: Aetna Commercial |
$174.93
|
| Rate for Payer: Aetna Medicare |
$71.92
|
| Rate for Payer: ASR ASR |
$188.54
|
| Rate for Payer: BCBS Complete |
$77.75
|
| Rate for Payer: BCBS Trust/PPO |
$160.26
|
| Rate for Payer: BCN Commercial |
$160.26
|
| Rate for Payer: Cash Price |
$155.50
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.50
|
| Rate for Payer: Healthscope Commercial |
$188.54
|
| Rate for Payer: Healthscope Whirlpool |
$194.37
|
| Rate for Payer: Mclaren Commercial |
$174.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.21
|
| Rate for Payer: Nomi Health Commercial |
$159.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$170.31
|
| Rate for Payer: Priority Health Narrow Network |
$136.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.05
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$38.87
|
|
|
Service Code
|
NDC 378912216
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$34.99
|
| Rate for Payer: ASR ASR |
$37.71
|
| Rate for Payer: BCBS Trust/PPO |
$31.92
|
| Rate for Payer: BCN Commercial |
$31.92
|
| Rate for Payer: Cash Price |
$31.10
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.10
|
| Rate for Payer: Healthscope Commercial |
$37.71
|
| Rate for Payer: Healthscope Whirlpool |
$38.87
|
| Rate for Payer: Mclaren Commercial |
$34.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.04
|
| Rate for Payer: Nomi Health Commercial |
$31.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.21
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$71.82
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$71.82 |
| Rate for Payer: Aetna Commercial |
$64.64
|
| Rate for Payer: Aetna Commercial |
$38.46
|
| Rate for Payer: Aetna Commercial |
$62.69
|
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: ASR ASR |
$41.45
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR ASR |
$69.66
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR ASR |
$67.57
|
| Rate for Payer: BCBS Trust/PPO |
$58.98
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCBS Trust/PPO |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$35.09
|
| Rate for Payer: BCN Commercial |
$35.09
|
| Rate for Payer: BCN Commercial |
$17.96
|
| Rate for Payer: BCN Commercial |
$57.20
|
| Rate for Payer: BCN Commercial |
$58.98
|
| Rate for Payer: BCN Commercial |
$17.53
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$57.45
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.45
|
| Rate for Payer: Healthscope Commercial |
$41.45
|
| Rate for Payer: Healthscope Commercial |
$21.21
|
| Rate for Payer: Healthscope Commercial |
$67.57
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Whirlpool |
$69.66
|
| Rate for Payer: Healthscope Whirlpool |
$71.82
|
| Rate for Payer: Healthscope Whirlpool |
$21.35
|
| Rate for Payer: Healthscope Whirlpool |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$42.73
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Mclaren Commercial |
$62.69
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$64.64
|
| Rate for Payer: Mclaren Commercial |
$38.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.04
|
| Rate for Payer: Nomi Health Commercial |
$57.12
|
| Rate for Payer: Nomi Health Commercial |
$35.04
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Nomi Health Commercial |
$58.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
OP
|
$42.73
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Aetna Commercial |
$38.46
|
| Rate for Payer: Aetna Commercial |
$64.64
|
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Commercial |
$62.69
|
| Rate for Payer: Aetna Medicare |
$26.57
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Aetna Medicare |
$25.77
|
| Rate for Payer: Aetna Medicare |
$15.81
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: ASR ASR |
$41.45
|
| Rate for Payer: ASR ASR |
$69.66
|
| Rate for Payer: ASR ASR |
$67.57
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: BCBS Complete |
$27.86
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Complete |
$28.73
|
| Rate for Payer: BCBS Complete |
$17.09
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$18.03
|
| Rate for Payer: BCBS Trust/PPO |
$57.43
|
| Rate for Payer: BCBS Trust/PPO |
$59.21
|
| Rate for Payer: BCBS Trust/PPO |
$35.23
|
| Rate for Payer: BCN Commercial |
$57.43
|
| Rate for Payer: BCN Commercial |
$18.03
|
| Rate for Payer: BCN Commercial |
$17.60
|
| Rate for Payer: BCN Commercial |
$59.21
|
| Rate for Payer: BCN Commercial |
$35.23
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$57.45
|
| Rate for Payer: Cash Price |
$57.45
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$67.51
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$40.16
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$21.21
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Commercial |
$41.45
|
| Rate for Payer: Healthscope Commercial |
$67.57
|
| Rate for Payer: Healthscope Whirlpool |
$42.73
|
| Rate for Payer: Healthscope Whirlpool |
$21.35
|
| Rate for Payer: Healthscope Whirlpool |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$71.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.66
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$64.64
|
| Rate for Payer: Mclaren Commercial |
$62.69
|
| Rate for Payer: Mclaren Commercial |
$38.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.32
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Nomi Health Commercial |
$58.89
|
| Rate for Payer: Nomi Health Commercial |
$57.12
|
| Rate for Payer: Nomi Health Commercial |
$35.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.60
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$17.57
|
| Rate for Payer: Aetna Commercial |
$24.46
|
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: ASR ASR |
$26.36
|
| Rate for Payer: ASR ASR |
$18.93
|
| Rate for Payer: ASR ASR |
$9.69
|
| Rate for Payer: ASR ASR |
$13.95
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR ASR |
$30.87
|
| Rate for Payer: BCBS Trust/PPO |
$8.20
|
| Rate for Payer: BCBS Trust/PPO |
$26.13
|
| Rate for Payer: BCBS Trust/PPO |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$14.69
|
| Rate for Payer: BCBS Trust/PPO |
$11.81
|
| Rate for Payer: BCBS Trust/PPO |
$17.53
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$26.13
|
| Rate for Payer: BCN Commercial |
$16.03
|
| Rate for Payer: BCN Commercial |
$14.69
|
| Rate for Payer: BCN Commercial |
$17.53
|
| Rate for Payer: BCN Commercial |
$22.32
|
| Rate for Payer: BCN Commercial |
$11.81
|
| Rate for Payer: BCN Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Healthscope Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Healthscope Commercial |
$13.95
|
| Rate for Payer: Healthscope Commercial |
$26.36
|
| Rate for Payer: Healthscope Commercial |
$30.87
|
| Rate for Payer: Healthscope Commercial |
$9.69
|
| Rate for Payer: Healthscope Whirlpool |
$27.17
|
| Rate for Payer: Healthscope Whirlpool |
$14.38
|
| Rate for Payer: Healthscope Whirlpool |
$17.89
|
| Rate for Payer: Healthscope Whirlpool |
$31.82
|
| Rate for Payer: Healthscope Whirlpool |
$19.52
|
| Rate for Payer: Healthscope Whirlpool |
$9.99
|
| Rate for Payer: Healthscope Whirlpool |
$21.35
|
| Rate for Payer: Mclaren Commercial |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$24.46
|
| Rate for Payer: Mclaren Commercial |
$28.64
|
| Rate for Payer: Mclaren Commercial |
$17.57
|
| Rate for Payer: Mclaren Commercial |
$8.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.59
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$22.28
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Nomi Health Commercial |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.91
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.35
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$21.35 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Commercial |
$17.57
|
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: Aetna Commercial |
$24.46
|
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Medicare |
$7.22
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna Medicare |
$11.77
|
| Rate for Payer: Aetna Medicare |
$10.05
|
| Rate for Payer: Aetna Medicare |
$3.70
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: ASR ASR |
$20.71
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: ASR ASR |
$13.95
|
| Rate for Payer: ASR ASR |
$18.93
|
| Rate for Payer: ASR ASR |
$30.87
|
| Rate for Payer: ASR ASR |
$9.69
|
| Rate for Payer: ASR ASR |
$26.36
|
| Rate for Payer: BCBS Complete |
$5.75
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS Complete |
$10.87
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS Complete |
$7.81
|
| Rate for Payer: BCBS Complete |
$8.54
|
| Rate for Payer: BCBS Trust/PPO |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$14.75
|
| Rate for Payer: BCBS Trust/PPO |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$26.24
|
| Rate for Payer: BCN Commercial |
$26.24
|
| Rate for Payer: BCN Commercial |
$22.40
|
| Rate for Payer: BCN Commercial |
$14.75
|
| Rate for Payer: BCN Commercial |
$11.86
|
| Rate for Payer: BCN Commercial |
$17.60
|
| Rate for Payer: BCN Commercial |
$16.09
|
| Rate for Payer: BCN Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$17.08
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$11.51
|
| Rate for Payer: Cofinity Commercial |
$20.07
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$30.87
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Healthscope Commercial |
$17.35
|
| Rate for Payer: Healthscope Commercial |
$13.95
|
| Rate for Payer: Healthscope Commercial |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$26.36
|
| Rate for Payer: Healthscope Commercial |
$20.71
|
| Rate for Payer: Healthscope Whirlpool |
$31.82
|
| Rate for Payer: Healthscope Whirlpool |
$21.35
|
| Rate for Payer: Healthscope Whirlpool |
$17.89
|
| Rate for Payer: Healthscope Whirlpool |
$9.99
|
| Rate for Payer: Healthscope Whirlpool |
$14.38
|
| Rate for Payer: Healthscope Whirlpool |
$27.17
|
| Rate for Payer: Healthscope Whirlpool |
$19.52
|
| Rate for Payer: Mclaren Commercial |
$12.95
|
| Rate for Payer: Mclaren Commercial |
$17.57
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Mclaren Commercial |
$24.46
|
| Rate for Payer: Mclaren Commercial |
$19.21
|
| Rate for Payer: Mclaren Commercial |
$28.64
|
| Rate for Payer: Mclaren Commercial |
$8.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: Nomi Health Commercial |
$14.67
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: Nomi Health Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$17.51
|
| Rate for Payer: Nomi Health Commercial |
$11.80
|
| Rate for Payer: Nomi Health Commercial |
$26.09
|
| Rate for Payer: Nomi Health Commercial |
$22.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.23
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: Priority Health Narrow Network |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.66
|
|
|
FERRIC CARBOXYMALTOSE 100 MG IRON/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
200735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: ASR ASR |
$485.00
|
| Rate for Payer: BCBS Trust/PPO |
$410.60
|
| Rate for Payer: BCN Commercial |
$410.60
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$470.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.00
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Whirlpool |
$500.00
|
| Rate for Payer: Mclaren Commercial |
$450.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.00
|
| Rate for Payer: Nomi Health Commercial |
$410.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.00
|
|
|
FERRIC CARBOXYMALTOSE 100 MG IRON/2 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
200735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$450.00
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.38
|
| Rate for Payer: ASR ASR |
$485.00
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$412.25
|
| Rate for Payer: BCN Commercial |
$412.25
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$470.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$485.00
|
| Rate for Payer: Healthscope Whirlpool |
$500.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.10
|
| Rate for Payer: Mclaren Commercial |
$450.00
|
| Rate for Payer: Mclaren Medicaid |
$1.10
|
| Rate for Payer: Mclaren Medicare |
$1.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.16
|
| Rate for Payer: Meridian Medicaid |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.00
|
| Rate for Payer: Nomi Health Commercial |
$410.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: PACE Medicare |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.21
|
| Rate for Payer: PHP Medicaid |
$0.59
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.16
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$440.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHCCP DNSP |
$1.10
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$1.10
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna Commercial |
$3,375.00
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.38
|
| Rate for Payer: ASR ASR |
$3,637.50
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,091.88
|
| Rate for Payer: BCN Commercial |
$3,091.88
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cofinity Commercial |
$3,525.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,000.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3,637.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,750.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.10
|
| Rate for Payer: Mclaren Commercial |
$3,375.00
|
| Rate for Payer: Mclaren Medicaid |
$1.10
|
| Rate for Payer: Mclaren Medicare |
$1.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.16
|
| Rate for Payer: Meridian Medicaid |
$0.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,187.50
|
| Rate for Payer: Nomi Health Commercial |
$3,075.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,812.50
|
| Rate for Payer: PACE Medicare |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.21
|
| Rate for Payer: PHP Medicaid |
$0.59
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.16
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,300.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.71
|
| Rate for Payer: UHC Medicaid |
$0.58
|
| Rate for Payer: UHCCP DNSP |
$1.10
|
| Rate for Payer: UHCCP Medicaid |
$0.58
|
| Rate for Payer: VA VA |
$1.10
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,812.50 |
| Max. Negotiated Rate |
$3,750.00 |
| Rate for Payer: Aetna Commercial |
$3,375.00
|
| Rate for Payer: ASR ASR |
$3,637.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,079.50
|
| Rate for Payer: BCN Commercial |
$3,079.50
|
| Rate for Payer: Cash Price |
$3,000.00
|
| Rate for Payer: Cofinity Commercial |
$3,525.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,000.00
|
| Rate for Payer: Healthscope Commercial |
$3,637.50
|
| Rate for Payer: Healthscope Whirlpool |
$3,750.00
|
| Rate for Payer: Mclaren Commercial |
$3,375.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,187.50
|
| Rate for Payer: Nomi Health Commercial |
$3,075.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,812.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,300.00
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,599.46
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$5,599.46 |
| Rate for Payer: Aetna Commercial |
$5,039.52
|
| Rate for Payer: Aetna Medicare |
$21.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.41
|
| Rate for Payer: ASR ASR |
$5,431.48
|
| Rate for Payer: BCBS Complete |
$12.04
|
| Rate for Payer: BCBS MAPPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,616.76
|
| Rate for Payer: BCN Commercial |
$4,616.76
|
| Rate for Payer: BCN Medicare Advantage |
$21.93
|
| Rate for Payer: Cash Price |
$4,479.57
|
| Rate for Payer: Cash Price |
$4,479.57
|
| Rate for Payer: Cofinity Commercial |
$5,263.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,479.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$5,431.48
|
| Rate for Payer: Healthscope Whirlpool |
$5,599.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.93
|
| Rate for Payer: Mclaren Commercial |
$5,039.52
|
| Rate for Payer: Mclaren Medicaid |
$21.93
|
| Rate for Payer: Mclaren Medicare |
$21.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.03
|
| Rate for Payer: Meridian Medicaid |
$12.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,759.54
|
| Rate for Payer: Nomi Health Commercial |
$4,591.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,199.60
|
| Rate for Payer: PACE Medicare |
$20.83
|
| Rate for Payer: PACE SWMI |
$21.93
|
| Rate for Payer: PHP Commercial |
$24.12
|
| Rate for Payer: PHP Medicaid |
$11.75
|
| Rate for Payer: PHP Medicare Advantage |
$21.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.69
|
| Rate for Payer: Priority Health Medicare |
$21.93
|
| Rate for Payer: Priority Health Narrow Network |
$18.95
|
| Rate for Payer: Railroad Medicare Medicare |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,927.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.93
|
| Rate for Payer: UHC Exchange |
$33.99
|
| Rate for Payer: UHC Medicaid |
$11.47
|
| Rate for Payer: UHCCP DNSP |
$21.93
|
| Rate for Payer: UHCCP Medicaid |
$11.47
|
| Rate for Payer: VA VA |
$21.93
|
|
