|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 65219053101
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: ASR Commercial |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$10.51
|
| Rate for Payer: BCN Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.90
|
| Rate for Payer: Healthscope Whirlpool |
$12.51
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
NDC 00338051913
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: ASR Commercial |
$194.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$163.78
|
| Rate for Payer: BCN Commercial |
$155.06
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$200.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.00
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.24
|
| Rate for Payer: Priority Health Narrow Network |
$140.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.00
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 00338051958
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Aetna Commercial |
$8.55
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: ASR ASR |
$9.22
|
| Rate for Payer: ASR Commercial |
$9.22
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: BCBS Trust/PPO |
$7.78
|
| Rate for Payer: BCN Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$9.50
|
| Rate for Payer: Healthscope Whirlpool |
$9.22
|
| Rate for Payer: Mclaren Commercial |
$8.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.08
|
| Rate for Payer: Nomi Health Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.32
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.36
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 00338051958
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Aetna Commercial |
$8.55
|
| Rate for Payer: ASR ASR |
$9.22
|
| Rate for Payer: ASR Commercial |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.37
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$9.50
|
| Rate for Payer: Healthscope Whirlpool |
$9.22
|
| Rate for Payer: Mclaren Commercial |
$8.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.08
|
| Rate for Payer: Nomi Health Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.36
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
NDC 65219053110
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$12.90 |
| Rate for Payer: Aetna Commercial |
$11.61
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: ASR ASR |
$12.51
|
| Rate for Payer: ASR Commercial |
$12.51
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.90
|
| Rate for Payer: Healthscope Whirlpool |
$12.51
|
| Rate for Payer: Mclaren Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: Nomi Health Commercial |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.30
|
| Rate for Payer: Priority Health Narrow Network |
$9.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.35
|
|
|
FAT EMULSION 20 % INTRAVENOUS
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
NDC 00338051913
|
| Hospital Charge Code |
10014
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$180.00
|
| Rate for Payer: ASR ASR |
$194.00
|
| Rate for Payer: ASR Commercial |
$194.00
|
| Rate for Payer: BCBS Trust/PPO |
$162.98
|
| Rate for Payer: BCN Commercial |
$155.06
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$188.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.00
|
| Rate for Payer: Healthscope Commercial |
$200.00
|
| Rate for Payer: Healthscope Whirlpool |
$194.00
|
| Rate for Payer: Mclaren Commercial |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.00
|
| Rate for Payer: Nomi Health Commercial |
$164.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.00
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
OP
|
$13.50
|
|
|
Service Code
|
NDC 00338954003
|
| Hospital Charge Code |
191280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: ASR ASR |
$13.10
|
| Rate for Payer: ASR Commercial |
$13.10
|
| Rate for Payer: BCBS Complete |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$11.06
|
| Rate for Payer: BCN Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.48
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.83
|
| Rate for Payer: Priority Health Narrow Network |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.88
|
|
|
FAT EMULSION-OLIVE OIL-SOYBEAN OIL-EGG PHOSPHOLIPID 20 % INTRAVENOUS
|
Facility
|
IP
|
$13.50
|
|
|
Service Code
|
NDC 00338954003
|
| Hospital Charge Code |
191280
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: ASR ASR |
$13.10
|
| Rate for Payer: ASR Commercial |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$11.00
|
| Rate for Payer: BCN Commercial |
$10.47
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$13.50
|
| Rate for Payer: Healthscope Whirlpool |
$13.10
|
| Rate for Payer: Mclaren Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.48
|
| Rate for Payer: Nomi Health Commercial |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.88
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: ASR Commercial |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$19.56
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
FAT EMULSION-SOYBEAN OIL-MCT-OLIVE OIL-FISH OIL 20 % INTRAVENOUS
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 63323082074
|
| Hospital Charge Code |
179808
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: ASR Commercial |
$23.28
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.03
|
| Rate for Payer: Priority Health Narrow Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$335.35
|
|
|
Service Code
|
NDC 13668013201
|
| Hospital Charge Code |
27489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.98 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$301.82
|
| Rate for Payer: ASR ASR |
$325.29
|
| Rate for Payer: ASR Commercial |
$325.29
|
| Rate for Payer: BCBS Trust/PPO |
$273.28
|
| Rate for Payer: BCN Commercial |
$260.00
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$315.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$335.35
|
| Rate for Payer: Healthscope Whirlpool |
$325.29
|
| Rate for Payer: Mclaren Commercial |
$301.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: Nomi Health Commercial |
$274.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.11
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 00603358121
|
| Hospital Charge Code |
27489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: ASR Commercial |
$259.80
|
| Rate for Payer: BCBS Trust/PPO |
$218.26
|
| Rate for Payer: BCN Commercial |
$207.66
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Healthscope Whirlpool |
$259.80
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 00603358121
|
| Hospital Charge Code |
27489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: ASR Commercial |
$259.80
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: BCBS Trust/PPO |
$219.33
|
| Rate for Payer: BCN Commercial |
$207.66
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Healthscope Whirlpool |
$259.80
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.68
|
| Rate for Payer: Priority Health Narrow Network |
$187.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
|
FELODIPINE ER 2.5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$335.35
|
|
|
Service Code
|
NDC 13668013201
|
| Hospital Charge Code |
27489
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.14 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$301.82
|
| Rate for Payer: Aetna Medicare |
$167.68
|
| Rate for Payer: ASR ASR |
$325.29
|
| Rate for Payer: ASR Commercial |
$325.29
|
| Rate for Payer: BCBS Complete |
$134.14
|
| Rate for Payer: BCBS Trust/PPO |
$274.62
|
| Rate for Payer: BCN Commercial |
$260.00
|
| Rate for Payer: Cash Price |
$268.28
|
| Rate for Payer: Cofinity Commercial |
$315.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.28
|
| Rate for Payer: Healthscope Commercial |
$335.35
|
| Rate for Payer: Healthscope Whirlpool |
$325.29
|
| Rate for Payer: Mclaren Commercial |
$301.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.05
|
| Rate for Payer: Nomi Health Commercial |
$274.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$293.83
|
| Rate for Payer: Priority Health Narrow Network |
$235.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.11
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
OP
|
$215.73
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.29 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$194.16
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: ASR ASR |
$209.26
|
| Rate for Payer: ASR Commercial |
$209.26
|
| Rate for Payer: BCBS Complete |
$86.29
|
| Rate for Payer: BCBS Trust/PPO |
$176.66
|
| Rate for Payer: BCN Commercial |
$167.26
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$202.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Healthscope Whirlpool |
$209.26
|
| Rate for Payer: Mclaren Commercial |
$194.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.02
|
| Rate for Payer: Priority Health Narrow Network |
$151.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.84
|
|
|
FENOFIBRATE NANOCRYSTALLIZED 48 MG TABLET
|
Facility
|
IP
|
$215.73
|
|
|
Service Code
|
NDC 69097045905
|
| Hospital Charge Code |
40009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.22 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$194.16
|
| Rate for Payer: ASR ASR |
$209.26
|
| Rate for Payer: ASR Commercial |
$209.26
|
| Rate for Payer: BCBS Trust/PPO |
$175.80
|
| Rate for Payer: BCN Commercial |
$167.26
|
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Cofinity Commercial |
$202.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.58
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Healthscope Whirlpool |
$209.26
|
| Rate for Payer: Mclaren Commercial |
$194.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.37
|
| Rate for Payer: Nomi Health Commercial |
$176.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.84
|
|
|
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 |
$34.09 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$47.20
|
| Rate for Payer: ASR ASR |
$50.87
|
| Rate for Payer: ASR Commercial |
$50.87
|
| Rate for Payer: BCBS Trust/PPO |
$42.73
|
| Rate for Payer: BCN Commercial |
$40.66
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$49.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$52.44
|
| Rate for Payer: Healthscope Whirlpool |
$50.87
|
| Rate for Payer: Mclaren Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.15
|
|
|
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 |
$20.98 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$47.20
|
| Rate for Payer: Aetna Medicare |
$26.22
|
| Rate for Payer: ASR ASR |
$50.87
|
| Rate for Payer: ASR Commercial |
$50.87
|
| Rate for Payer: BCBS Complete |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$42.94
|
| Rate for Payer: BCN Commercial |
$40.66
|
| Rate for Payer: Cash Price |
$41.95
|
| Rate for Payer: Cofinity Commercial |
$49.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.95
|
| Rate for Payer: Healthscope Commercial |
$52.44
|
| Rate for Payer: Healthscope Whirlpool |
$50.87
|
| Rate for Payer: Mclaren Commercial |
$47.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.57
|
| Rate for Payer: Nomi Health Commercial |
$43.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.95
|
| Rate for Payer: Priority Health Narrow Network |
$36.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.15
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$262.18
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$235.96
|
| Rate for Payer: Aetna Medicare |
$131.09
|
| Rate for Payer: ASR ASR |
$254.31
|
| Rate for Payer: ASR Commercial |
$254.31
|
| Rate for Payer: BCBS Complete |
$104.87
|
| Rate for Payer: BCBS Trust/PPO |
$214.70
|
| Rate for Payer: BCN Commercial |
$203.27
|
| Rate for Payer: Cash Price |
$209.75
|
| Rate for Payer: Cofinity Commercial |
$246.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$262.18
|
| Rate for Payer: Healthscope Whirlpool |
$254.31
|
| Rate for Payer: Mclaren Commercial |
$235.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$214.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.72
|
| Rate for Payer: Priority Health Narrow Network |
$183.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.72
|
|
|
FENTANYL 12 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$262.18
|
|
|
Service Code
|
NDC 00378911998
|
| Hospital Charge Code |
41382
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.42 |
| Max. Negotiated Rate |
$262.18 |
| Rate for Payer: Aetna Commercial |
$235.96
|
| Rate for Payer: ASR ASR |
$254.31
|
| Rate for Payer: ASR Commercial |
$254.31
|
| Rate for Payer: BCBS Trust/PPO |
$213.65
|
| Rate for Payer: BCN Commercial |
$203.27
|
| Rate for Payer: Cash Price |
$209.75
|
| Rate for Payer: Cofinity Commercial |
$246.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.74
|
| Rate for Payer: Healthscope Commercial |
$262.18
|
| Rate for Payer: Healthscope Whirlpool |
$254.31
|
| Rate for Payer: Mclaren Commercial |
$235.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.85
|
| Rate for Payer: Nomi Health Commercial |
$214.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$230.72
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$22.36
|
|
|
Service Code
|
NDC 00378912116
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: ASR ASR |
$21.69
|
| Rate for Payer: ASR Commercial |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Whirlpool |
$21.69
|
| Rate for Payer: Mclaren Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.68
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$22.36
|
|
|
Service Code
|
NDC 00378912116
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$20.12
|
| Rate for Payer: Aetna Medicare |
$11.18
|
| Rate for Payer: ASR ASR |
$21.69
|
| Rate for Payer: ASR Commercial |
$21.69
|
| Rate for Payer: BCBS Complete |
$8.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.31
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: Cash Price |
$17.88
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.89
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Healthscope Whirlpool |
$21.69
|
| Rate for Payer: Mclaren Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.01
|
| Rate for Payer: Nomi Health Commercial |
$18.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.59
|
| Rate for Payer: Priority Health Narrow Network |
$15.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.68
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
OP
|
$111.77
|
|
|
Service Code
|
NDC 00378912198
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.71 |
| Max. Negotiated Rate |
$111.77 |
| Rate for Payer: Aetna Commercial |
$100.59
|
| Rate for Payer: Aetna Medicare |
$55.88
|
| Rate for Payer: ASR ASR |
$108.42
|
| Rate for Payer: ASR Commercial |
$108.42
|
| Rate for Payer: BCBS Complete |
$44.71
|
| Rate for Payer: BCBS Trust/PPO |
$91.53
|
| Rate for Payer: BCN Commercial |
$86.66
|
| Rate for Payer: Cash Price |
$89.42
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.42
|
| Rate for Payer: Healthscope Commercial |
$111.77
|
| Rate for Payer: Healthscope Whirlpool |
$108.42
|
| Rate for Payer: Mclaren Commercial |
$100.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.00
|
| Rate for Payer: Nomi Health Commercial |
$91.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.93
|
| Rate for Payer: Priority Health Narrow Network |
$78.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.36
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$111.77
|
|
|
Service Code
|
NDC 00378912198
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$111.77 |
| Rate for Payer: Aetna Commercial |
$100.59
|
| Rate for Payer: ASR ASR |
$108.42
|
| Rate for Payer: ASR Commercial |
$108.42
|
| Rate for Payer: BCBS Trust/PPO |
$91.08
|
| Rate for Payer: BCN Commercial |
$86.66
|
| Rate for Payer: Cash Price |
$89.42
|
| Rate for Payer: Cofinity Commercial |
$105.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.42
|
| Rate for Payer: Healthscope Commercial |
$111.77
|
| Rate for Payer: Healthscope Whirlpool |
$108.42
|
| Rate for Payer: Mclaren Commercial |
$100.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.00
|
| Rate for Payer: Nomi Health Commercial |
$91.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.36
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$54.13
|
|
|
Service Code
|
NDC 60505701202
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.18 |
| Max. Negotiated Rate |
$54.13 |
| Rate for Payer: Aetna Commercial |
$48.72
|
| Rate for Payer: ASR ASR |
$52.51
|
| Rate for Payer: ASR Commercial |
$52.51
|
| Rate for Payer: BCBS Trust/PPO |
$44.11
|
| Rate for Payer: BCN Commercial |
$41.97
|
| Rate for Payer: Cash Price |
$43.31
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.30
|
| Rate for Payer: Healthscope Commercial |
$54.13
|
| Rate for Payer: Healthscope Whirlpool |
$52.51
|
| Rate for Payer: Mclaren Commercial |
$48.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.01
|
| Rate for Payer: Nomi Health Commercial |
$44.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.63
|
|
