|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 60505-7006-0
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: ASR ASR |
$9.06
|
| Rate for Payer: BCBS Trust/PPO |
$7.24
|
| Rate for Payer: BCN Commercial |
$7.24
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Healthscope Whirlpool |
$9.06
|
| Rate for Payer: Mclaren Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.22
|
|
|
FENTANYL 25 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$46.68
|
|
|
Service Code
|
NDC 60505-7006-2
|
| Hospital Charge Code |
27905
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Aetna Commercial |
$42.01
|
| Rate for Payer: ASR ASR |
$45.28
|
| Rate for Payer: BCBS Trust/PPO |
$36.19
|
| Rate for Payer: BCN Commercial |
$36.19
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cofinity Commercial |
$43.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.34
|
| Rate for Payer: Healthscope Commercial |
$46.68
|
| Rate for Payer: Healthscope Whirlpool |
$45.28
|
| Rate for Payer: Mclaren Commercial |
$42.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.08
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.23
|
|
|
Service Code
|
NDC 60505-7007-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$78.23 |
| Rate for Payer: Aetna Commercial |
$70.41
|
| Rate for Payer: ASR ASR |
$75.88
|
| Rate for Payer: BCBS Trust/PPO |
$60.65
|
| Rate for Payer: BCN Commercial |
$60.65
|
| Rate for Payer: Cash Price |
$62.59
|
| Rate for Payer: Cofinity Commercial |
$73.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.58
|
| Rate for Payer: Healthscope Commercial |
$78.23
|
| Rate for Payer: Healthscope Whirlpool |
$75.88
|
| Rate for Payer: Mclaren Commercial |
$70.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.84
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$39.71
|
|
|
Service Code
|
NDC 0378-9122-16
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$39.71 |
| Rate for Payer: Aetna Commercial |
$35.74
|
| Rate for Payer: ASR ASR |
$38.52
|
| Rate for Payer: BCBS Trust/PPO |
$30.79
|
| Rate for Payer: BCN Commercial |
$30.79
|
| Rate for Payer: Cash Price |
$31.76
|
| Rate for Payer: Cofinity Commercial |
$37.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.77
|
| Rate for Payer: Healthscope Commercial |
$39.71
|
| Rate for Payer: Healthscope Whirlpool |
$38.52
|
| Rate for Payer: Mclaren Commercial |
$35.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.94
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$54.13
|
|
|
Service Code
|
NDC 60505-7012-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.89 |
| Max. Negotiated Rate |
$54.13 |
| Rate for Payer: Aetna Commercial |
$48.72
|
| Rate for Payer: ASR ASR |
$52.51
|
| Rate for Payer: BCBS Trust/PPO |
$41.97
|
| 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 Multiplan/Beech St/PHCS |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.63
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$15.65
|
|
|
Service Code
|
NDC 60505-7007-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: ASR ASR |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Commercial |
$12.13
|
| Rate for Payer: Cash Price |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.52
|
| Rate for Payer: Healthscope Commercial |
$15.65
|
| Rate for Payer: Healthscope Whirlpool |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.77
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$15.65
|
|
|
Service Code
|
NDC 60505-7012-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Aetna Commercial |
$14.08
|
| Rate for Payer: ASR ASR |
$15.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Commercial |
$12.13
|
| Rate for Payer: Cash Price |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.52
|
| Rate for Payer: Healthscope Commercial |
$15.65
|
| Rate for Payer: Healthscope Whirlpool |
$15.18
|
| Rate for Payer: Mclaren Commercial |
$14.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.77
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$30.08
|
|
|
Service Code
|
NDC 60505-7082-0
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$30.08 |
| Rate for Payer: Aetna Commercial |
$27.07
|
| Rate for Payer: ASR ASR |
$29.18
|
| Rate for Payer: BCBS Trust/PPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: Cash Price |
$24.06
|
| Rate for Payer: Cofinity Commercial |
$28.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.06
|
| Rate for Payer: Healthscope Commercial |
$30.08
|
| Rate for Payer: Healthscope Whirlpool |
$29.18
|
| Rate for Payer: Mclaren Commercial |
$27.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.47
|
|
|
FENTANYL 50 MCG/HR TRANSDERMAL PATCH
|
Facility
|
IP
|
$150.38
|
|
|
Service Code
|
NDC 60505-7082-2
|
| Hospital Charge Code |
27906
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.27 |
| Max. Negotiated Rate |
$150.38 |
| Rate for Payer: Aetna Commercial |
$135.34
|
| Rate for Payer: ASR ASR |
$145.87
|
| Rate for Payer: BCBS Trust/PPO |
$116.59
|
| Rate for Payer: BCN Commercial |
$116.59
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cofinity Commercial |
$141.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.30
|
| Rate for Payer: Healthscope Commercial |
$150.38
|
| Rate for Payer: Healthscope Whirlpool |
$145.87
|
| Rate for Payer: Mclaren Commercial |
$135.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.33
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION (CODE)
|
Facility
|
IP
|
$42.73
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
163724
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Aetna Commercial |
$38.46
|
| Rate for Payer: Aetna Commercial |
$20.34
|
| Rate for Payer: Aetna Commercial |
$19.68
|
| Rate for Payer: Aetna Commercial |
$62.69
|
| Rate for Payer: Aetna Commercial |
$31.24
|
| Rate for Payer: ASR ASR |
$41.45
|
| Rate for Payer: ASR ASR |
$21.21
|
| Rate for Payer: ASR ASR |
$21.92
|
| Rate for Payer: ASR ASR |
$33.67
|
| Rate for Payer: ASR ASR |
$67.57
|
| Rate for Payer: BCBS Trust/PPO |
$26.91
|
| Rate for Payer: BCBS Trust/PPO |
$33.13
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.52
|
| Rate for Payer: BCBS Trust/PPO |
$54.01
|
| Rate for Payer: BCN Commercial |
$26.91
|
| Rate for Payer: BCN Commercial |
$33.13
|
| Rate for Payer: BCN Commercial |
$17.52
|
| Rate for Payer: BCN Commercial |
$16.96
|
| Rate for Payer: BCN Commercial |
$54.01
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$18.08
|
| Rate for Payer: Cash Price |
$55.73
|
| Rate for Payer: Cash Price |
$34.18
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: Cofinity Commercial |
$40.17
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Commercial |
$21.24
|
| Rate for Payer: Cofinity Commercial |
$20.56
|
| Rate for Payer: Cofinity Commercial |
$32.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.73
|
| 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 |
$18.08
|
| Rate for Payer: Healthscope Commercial |
$69.66
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Healthscope Whirlpool |
$21.92
|
| Rate for Payer: Healthscope Whirlpool |
$33.67
|
| Rate for Payer: Healthscope Whirlpool |
$41.45
|
| Rate for Payer: Healthscope Whirlpool |
$21.21
|
| Rate for Payer: Healthscope Whirlpool |
$67.57
|
| Rate for Payer: Mclaren Commercial |
$38.46
|
| Rate for Payer: Mclaren Commercial |
$62.69
|
| Rate for Payer: Mclaren Commercial |
$20.34
|
| Rate for Payer: Mclaren Commercial |
$31.24
|
| Rate for Payer: Mclaren Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.30
|
|
|
FENTANYL (PF) 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$9.99
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
3037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$9.99 |
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Aetna Commercial |
$28.64
|
| Rate for Payer: Aetna Commercial |
$31.24
|
| Rate for Payer: Aetna Commercial |
$9.29
|
| Rate for Payer: Aetna Commercial |
$21.15
|
| Rate for Payer: Aetna Commercial |
$20.45
|
| Rate for Payer: Aetna Commercial |
$17.57
|
| Rate for Payer: ASR ASR |
$22.04
|
| Rate for Payer: ASR ASR |
$10.01
|
| Rate for Payer: ASR ASR |
$30.87
|
| Rate for Payer: ASR ASR |
$22.80
|
| Rate for Payer: ASR ASR |
$18.93
|
| Rate for Payer: ASR ASR |
$9.69
|
| Rate for Payer: ASR ASR |
$33.67
|
| Rate for Payer: BCBS Trust/PPO |
$26.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$24.67
|
| Rate for Payer: BCBS Trust/PPO |
$7.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.61
|
| Rate for Payer: BCBS Trust/PPO |
$18.22
|
| Rate for Payer: BCN Commercial |
$18.22
|
| Rate for Payer: BCN Commercial |
$17.61
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: BCN Commercial |
$8.00
|
| Rate for Payer: BCN Commercial |
$24.67
|
| Rate for Payer: BCN Commercial |
$7.75
|
| Rate for Payer: BCN Commercial |
$26.91
|
| Rate for Payer: Cash Price |
$7.99
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cash Price |
$18.17
|
| Rate for Payer: Cash Price |
$27.76
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$29.91
|
| Rate for Payer: Cofinity Commercial |
$22.09
|
| Rate for Payer: Cofinity Commercial |
$9.39
|
| Rate for Payer: Cofinity Commercial |
$9.70
|
| Rate for Payer: Cofinity Commercial |
$32.63
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$22.72
|
| Rate for Payer: Healthscope Commercial |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$9.99
|
| Rate for Payer: Healthscope Whirlpool |
$22.04
|
| Rate for Payer: Healthscope Whirlpool |
$22.80
|
| Rate for Payer: Healthscope Whirlpool |
$9.69
|
| Rate for Payer: Healthscope Whirlpool |
$10.01
|
| Rate for Payer: Healthscope Whirlpool |
$18.93
|
| Rate for Payer: Healthscope Whirlpool |
$30.87
|
| Rate for Payer: Healthscope Whirlpool |
$33.67
|
| Rate for Payer: Mclaren Commercial |
$9.29
|
| Rate for Payer: Mclaren Commercial |
$8.99
|
| Rate for Payer: Mclaren Commercial |
$20.45
|
| Rate for Payer: Mclaren Commercial |
$21.15
|
| Rate for Payer: Mclaren Commercial |
$31.24
|
| Rate for Payer: Mclaren Commercial |
$17.57
|
| Rate for Payer: Mclaren Commercial |
$28.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.79
|
|
|
FERRIC CARBOXYMALTOSE 100 MG IRON/2 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$611.03
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
200735
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$427.72 |
| Max. Negotiated Rate |
$611.03 |
| Rate for Payer: Aetna Commercial |
$549.93
|
| Rate for Payer: ASR ASR |
$592.70
|
| Rate for Payer: BCBS Trust/PPO |
$473.73
|
| Rate for Payer: BCN Commercial |
$473.73
|
| Rate for Payer: Cash Price |
$488.82
|
| Rate for Payer: Cofinity Commercial |
$574.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.82
|
| Rate for Payer: Healthscope Commercial |
$611.03
|
| Rate for Payer: Healthscope Whirlpool |
$592.70
|
| Rate for Payer: Mclaren Commercial |
$549.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$519.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$537.71
|
|
|
FERRIC CARBOXYMALTOSE 50 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,978.83
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
167398
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,085.18 |
| Max. Negotiated Rate |
$2,978.83 |
| Rate for Payer: Aetna Commercial |
$2,680.95
|
| Rate for Payer: ASR ASR |
$2,889.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,309.49
|
| Rate for Payer: BCN Commercial |
$2,309.49
|
| Rate for Payer: Cash Price |
$2,383.07
|
| Rate for Payer: Cofinity Commercial |
$2,800.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,383.06
|
| Rate for Payer: Healthscope Commercial |
$2,978.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,889.47
|
| Rate for Payer: Mclaren Commercial |
$2,680.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,532.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,621.37
|
|
|
FERRIC DERISOMALTOSE 100 MG IRON/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,694.62
|
|
|
Service Code
|
HCPCS J1437
|
| Hospital Charge Code |
194928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,986.23 |
| Max. Negotiated Rate |
$5,694.62 |
| Rate for Payer: Aetna Commercial |
$5,125.16
|
| Rate for Payer: ASR ASR |
$5,523.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,415.04
|
| Rate for Payer: BCN Commercial |
$4,415.04
|
| Rate for Payer: Cash Price |
$4,555.70
|
| Rate for Payer: Cofinity Commercial |
$5,352.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,555.70
|
| Rate for Payer: Healthscope Commercial |
$5,694.62
|
| Rate for Payer: Healthscope Whirlpool |
$5,523.78
|
| Rate for Payer: Mclaren Commercial |
$5,125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,840.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,986.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,011.27
|
|
|
FERRIC SUBSULFATE 0.2 GRAM TO 0.22 GRAM/ML TOPICAL SOLN AND APPLICATOR
|
Facility
|
IP
|
$58.94
|
|
|
Service Code
|
NDC 10481-0112-8
|
| Hospital Charge Code |
167585
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.26 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: ASR ASR |
$57.17
|
| Rate for Payer: BCBS Trust/PPO |
$45.70
|
| Rate for Payer: BCN Commercial |
$45.70
|
| Rate for Payer: Cash Price |
$47.15
|
| Rate for Payer: Cofinity Commercial |
$55.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.15
|
| Rate for Payer: Healthscope Commercial |
$58.94
|
| Rate for Payer: Healthscope Whirlpool |
$57.17
|
| Rate for Payer: Mclaren Commercial |
$53.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.87
|
|
|
FERROUS SULFATE 325 MG (65 MG IRON) TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 904759161
|
| Hospital Charge Code |
3074
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$52.88
|
| Rate for Payer: ASR ASR |
$56.99
|
| Rate for Payer: BCBS Trust/PPO |
$45.55
|
| Rate for Payer: BCN Commercial |
$45.55
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$55.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Healthscope Whirlpool |
$56.99
|
| Rate for Payer: Mclaren Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.70
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$11,443.85
|
|
|
Service Code
|
MS-DRG 864
|
| Min. Negotiated Rate |
$8,697.33 |
| Max. Negotiated Rate |
$11,443.85 |
| Rate for Payer: Aetna Medicare |
$9,155.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,443.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,443.85
|
| Rate for Payer: BCBS MAPPO |
$9,155.08
|
| Rate for Payer: BCN Medicare Advantage |
$9,155.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,155.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,155.08
|
| Rate for Payer: Mclaren Medicare |
$9,155.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,612.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,528.34
|
| Rate for Payer: PACE Medicare |
$8,697.33
|
| Rate for Payer: PACE SWMI |
$9,155.08
|
| Rate for Payer: PHP Commercial |
$10,070.59
|
| Rate for Payer: PHP Medicare Advantage |
$9,155.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,335.15
|
| Rate for Payer: Priority Health Medicare |
$9,155.08
|
| Rate for Payer: Priority Health Narrow Network |
$9,068.12
|
| Rate for Payer: Railroad Medicare Medicare |
$9,155.08
|
| Rate for Payer: UHC Medicare Advantage |
$9,429.73
|
| Rate for Payer: VA VA |
$9,155.08
|
|
|
FIBERSOURCE HN BOLUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018555
|
| Hospital Charge Code |
161567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN CONTINUOUS FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018555
|
| Hospital Charge Code |
168938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN CYCLIC FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018555
|
| Hospital Charge Code |
200077
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIBERSOURCE HN INTERMITTENT FEED
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 4390018555
|
| Hospital Charge Code |
200076
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
FIDAXOMICIN 200 MG TABLET
|
Facility
|
IP
|
$17,138.77
|
|
|
Service Code
|
NDC 52015-080-01
|
| Hospital Charge Code |
152861
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,997.14 |
| Max. Negotiated Rate |
$17,138.77 |
| Rate for Payer: Aetna Commercial |
$15,424.89
|
| Rate for Payer: ASR ASR |
$16,624.61
|
| Rate for Payer: BCBS Trust/PPO |
$13,287.69
|
| Rate for Payer: BCN Commercial |
$13,287.69
|
| Rate for Payer: Cash Price |
$13,711.02
|
| Rate for Payer: Cofinity Commercial |
$16,110.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,711.02
|
| Rate for Payer: Healthscope Commercial |
$17,138.77
|
| Rate for Payer: Healthscope Whirlpool |
$16,624.61
|
| Rate for Payer: Mclaren Commercial |
$15,424.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,567.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,997.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,082.12
|
|
|
FILGRASTIM-AAFI 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$787.14
|
|
|
Service Code
|
HCPCS Q5110
|
| Hospital Charge Code |
188115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$551.00 |
| Max. Negotiated Rate |
$787.14 |
| Rate for Payer: Aetna Commercial |
$708.43
|
| Rate for Payer: ASR ASR |
$763.53
|
| Rate for Payer: BCBS Trust/PPO |
$610.27
|
| Rate for Payer: BCN Commercial |
$610.27
|
| Rate for Payer: Cash Price |
$629.71
|
| Rate for Payer: Cofinity Commercial |
$739.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.71
|
| Rate for Payer: Healthscope Commercial |
$787.14
|
| Rate for Payer: Healthscope Whirlpool |
$763.53
|
| Rate for Payer: Mclaren Commercial |
$708.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$692.68
|
|
|
FILGRASTIM-SNDZ 300 MCG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$707.48
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$495.24 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$636.73
|
| Rate for Payer: ASR ASR |
$686.26
|
| Rate for Payer: BCBS Trust/PPO |
$548.51
|
| Rate for Payer: BCN Commercial |
$548.51
|
| Rate for Payer: Cash Price |
$565.98
|
| Rate for Payer: Cofinity Commercial |
$665.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.98
|
| Rate for Payer: Healthscope Commercial |
$707.48
|
| Rate for Payer: Healthscope Whirlpool |
$686.26
|
| Rate for Payer: Mclaren Commercial |
$636.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$601.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.58
|
|
|
FILGRASTIM-SNDZ 480 MCG/0.8 ML INJECTION SYRINGE
|
Facility
|
IP
|
$1,020.35
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
175518
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$714.24 |
| Max. Negotiated Rate |
$1,020.35 |
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: Aetna Commercial |
$918.32
|
| Rate for Payer: ASR ASR |
$989.74
|
| Rate for Payer: ASR ASR |
$989.75
|
| Rate for Payer: BCBS Trust/PPO |
$791.08
|
| Rate for Payer: BCBS Trust/PPO |
$791.09
|
| Rate for Payer: BCN Commercial |
$791.08
|
| Rate for Payer: BCN Commercial |
$791.09
|
| Rate for Payer: Cash Price |
$816.29
|
| Rate for Payer: Cash Price |
$816.28
|
| Rate for Payer: Cofinity Commercial |
$959.13
|
| Rate for Payer: Cofinity Commercial |
$959.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$816.28
|
| Rate for Payer: Healthscope Commercial |
$1,020.35
|
| Rate for Payer: Healthscope Commercial |
$1,020.36
|
| Rate for Payer: Healthscope Whirlpool |
$989.74
|
| Rate for Payer: Healthscope Whirlpool |
$989.75
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Mclaren Commercial |
$918.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$867.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$897.92
|
|
