|
MORPHINE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$30.80
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
186563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.88
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.64
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Whirlpool |
$29.88
|
| Rate for Payer: Mclaren Commercial |
$27.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$24.77
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna Commercial |
$22.29
|
| Rate for Payer: ASR ASR |
$24.03
|
| Rate for Payer: BCBS Trust/PPO |
$19.20
|
| Rate for Payer: BCN Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$23.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$24.77
|
| Rate for Payer: Healthscope Whirlpool |
$24.03
|
| Rate for Payer: Mclaren Commercial |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.80
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$14.71
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$14.71 |
| Rate for Payer: Aetna Commercial |
$13.24
|
| Rate for Payer: Aetna Commercial |
$23.37
|
| Rate for Payer: ASR ASR |
$25.19
|
| Rate for Payer: ASR ASR |
$14.27
|
| Rate for Payer: BCBS Trust/PPO |
$11.40
|
| Rate for Payer: BCBS Trust/PPO |
$20.13
|
| Rate for Payer: BCN Commercial |
$11.40
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$24.41
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$14.71
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Whirlpool |
$14.27
|
| Rate for Payer: Healthscope Whirlpool |
$25.19
|
| Rate for Payer: Mclaren Commercial |
$23.37
|
| Rate for Payer: Mclaren Commercial |
$13.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.85
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
NDC 68094-045-58
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: ASR ASR |
$10.42
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$8.33
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$10.74
|
| Rate for Payer: Healthscope Whirlpool |
$10.42
|
| Rate for Payer: Mclaren Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.45
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$10.74
|
|
|
Service Code
|
NDC 68094-045-01
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Aetna Commercial |
$9.67
|
| Rate for Payer: ASR ASR |
$10.42
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$8.33
|
| Rate for Payer: Cash Price |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$10.74
|
| Rate for Payer: Healthscope Whirlpool |
$10.42
|
| Rate for Payer: Mclaren Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.45
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 68084-403-11
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.29
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 0406-8315-23
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$5.45 |
| Rate for Payer: Aetna Commercial |
$4.90
|
| Rate for Payer: ASR ASR |
$5.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.23
|
| Rate for Payer: BCN Commercial |
$4.23
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cofinity Commercial |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.36
|
| Rate for Payer: Healthscope Commercial |
$5.45
|
| Rate for Payer: Healthscope Whirlpool |
$5.29
|
| Rate for Payer: Mclaren Commercial |
$4.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.80
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$911.75
|
|
|
Service Code
|
NDC 0904-6557-61
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$638.22 |
| Max. Negotiated Rate |
$911.75 |
| Rate for Payer: Aetna Commercial |
$820.58
|
| Rate for Payer: ASR ASR |
$884.40
|
| Rate for Payer: BCBS Trust/PPO |
$706.88
|
| Rate for Payer: BCN Commercial |
$706.88
|
| Rate for Payer: Cash Price |
$729.40
|
| Rate for Payer: Cofinity Commercial |
$857.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.40
|
| Rate for Payer: Healthscope Commercial |
$911.75
|
| Rate for Payer: Healthscope Whirlpool |
$884.40
|
| Rate for Payer: Mclaren Commercial |
$820.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$802.34
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$431.90
|
|
|
Service Code
|
NDC 0406-8315-01
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.33 |
| Max. Negotiated Rate |
$431.90 |
| Rate for Payer: Aetna Commercial |
$388.71
|
| Rate for Payer: ASR ASR |
$418.94
|
| Rate for Payer: BCBS Trust/PPO |
$334.85
|
| Rate for Payer: BCN Commercial |
$334.85
|
| Rate for Payer: Cash Price |
$345.52
|
| Rate for Payer: Cofinity Commercial |
$405.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.52
|
| Rate for Payer: Healthscope Commercial |
$431.90
|
| Rate for Payer: Healthscope Whirlpool |
$418.94
|
| Rate for Payer: Mclaren Commercial |
$388.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.07
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$346.50
|
|
|
Service Code
|
NDC 42858-801-01
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.55 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: ASR ASR |
$336.10
|
| Rate for Payer: BCBS Trust/PPO |
$268.64
|
| Rate for Payer: BCN Commercial |
$268.64
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cofinity Commercial |
$325.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.20
|
| Rate for Payer: Healthscope Commercial |
$346.50
|
| Rate for Payer: Healthscope Whirlpool |
$336.10
|
| Rate for Payer: Mclaren Commercial |
$311.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.92
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$545.30
|
|
|
Service Code
|
NDC 0406-8315-62
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.71 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Aetna Commercial |
$490.77
|
| Rate for Payer: ASR ASR |
$528.94
|
| Rate for Payer: BCBS Trust/PPO |
$422.77
|
| Rate for Payer: BCN Commercial |
$422.77
|
| Rate for Payer: Cash Price |
$436.24
|
| Rate for Payer: Cofinity Commercial |
$512.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.24
|
| Rate for Payer: Healthscope Commercial |
$545.30
|
| Rate for Payer: Healthscope Whirlpool |
$528.94
|
| Rate for Payer: Mclaren Commercial |
$490.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$463.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$479.86
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$424.20
|
|
|
Service Code
|
NDC 68084-403-01
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$424.20 |
| Rate for Payer: Aetna Commercial |
$381.78
|
| Rate for Payer: ASR ASR |
$411.47
|
| Rate for Payer: BCBS Trust/PPO |
$328.88
|
| Rate for Payer: BCN Commercial |
$328.88
|
| Rate for Payer: Cash Price |
$339.36
|
| Rate for Payer: Cofinity Commercial |
$398.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$339.36
|
| Rate for Payer: Healthscope Commercial |
$424.20
|
| Rate for Payer: Healthscope Whirlpool |
$411.47
|
| Rate for Payer: Mclaren Commercial |
$381.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$360.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.30
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,036.70
|
|
|
Service Code
|
NDC 0406-8330-62
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$1,036.70 |
| Rate for Payer: Aetna Commercial |
$933.03
|
| Rate for Payer: ASR ASR |
$1,005.60
|
| Rate for Payer: BCBS Trust/PPO |
$803.75
|
| Rate for Payer: BCN Commercial |
$803.75
|
| Rate for Payer: Cash Price |
$829.36
|
| Rate for Payer: Cofinity Commercial |
$974.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$829.36
|
| Rate for Payer: Healthscope Commercial |
$1,036.70
|
| Rate for Payer: Healthscope Whirlpool |
$1,005.60
|
| Rate for Payer: Mclaren Commercial |
$933.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$881.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$912.30
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$10.37
|
|
|
Service Code
|
NDC 0406-8330-23
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.26 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: ASR ASR |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$8.04
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.30
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Healthscope Whirlpool |
$10.06
|
| Rate for Payer: Mclaren Commercial |
$9.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.13
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
NDC 0904-6558-61
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$494.90 |
| Max. Negotiated Rate |
$707.00 |
| Rate for Payer: Aetna Commercial |
$636.30
|
| Rate for Payer: ASR ASR |
$685.79
|
| Rate for Payer: BCBS Trust/PPO |
$548.14
|
| Rate for Payer: BCN Commercial |
$548.14
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$664.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$565.60
|
| Rate for Payer: Healthscope Commercial |
$707.00
|
| Rate for Payer: Healthscope Whirlpool |
$685.79
|
| Rate for Payer: Mclaren Commercial |
$636.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$600.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$622.16
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Whirlpool |
$11.27
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$127.95
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.56 |
| Max. Negotiated Rate |
$127.95 |
| Rate for Payer: Aetna Commercial |
$115.16
|
| Rate for Payer: Aetna Commercial |
$34.70
|
| Rate for Payer: ASR ASR |
$37.39
|
| Rate for Payer: ASR ASR |
$124.11
|
| Rate for Payer: BCBS Trust/PPO |
$99.20
|
| Rate for Payer: BCBS Trust/PPO |
$29.89
|
| Rate for Payer: BCN Commercial |
$29.89
|
| Rate for Payer: BCN Commercial |
$99.20
|
| Rate for Payer: Cash Price |
$102.36
|
| Rate for Payer: Cash Price |
$30.84
|
| Rate for Payer: Cofinity Commercial |
$36.24
|
| Rate for Payer: Cofinity Commercial |
$120.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.84
|
| Rate for Payer: Healthscope Commercial |
$38.55
|
| Rate for Payer: Healthscope Commercial |
$127.95
|
| Rate for Payer: Healthscope Whirlpool |
$37.39
|
| Rate for Payer: Healthscope Whirlpool |
$124.11
|
| Rate for Payer: Mclaren Commercial |
$34.70
|
| Rate for Payer: Mclaren Commercial |
$115.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.60
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.01
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Whirlpool |
$11.27
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$19,320.35
|
|
|
Service Code
|
MS-DRG 137
|
| Min. Negotiated Rate |
$13,699.29 |
| Max. Negotiated Rate |
$19,320.35 |
| Rate for Payer: Aetna Medicare |
$14,420.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,025.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,025.39
|
| Rate for Payer: BCBS MAPPO |
$14,420.31
|
| Rate for Payer: BCN Medicare Advantage |
$14,420.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,420.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,420.31
|
| Rate for Payer: Mclaren Medicare |
$14,420.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,141.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,583.36
|
| Rate for Payer: PACE Medicare |
$13,699.29
|
| Rate for Payer: PACE SWMI |
$14,420.31
|
| Rate for Payer: PHP Commercial |
$15,862.34
|
| Rate for Payer: PHP Medicare Advantage |
$14,420.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,320.35
|
| Rate for Payer: Priority Health Medicare |
$14,420.31
|
| Rate for Payer: Priority Health Narrow Network |
$15,456.28
|
| Rate for Payer: Railroad Medicare Medicare |
$14,420.31
|
| Rate for Payer: UHC Medicare Advantage |
$14,852.92
|
| Rate for Payer: VA VA |
$14,420.31
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,262.88
|
|
|
Service Code
|
MS-DRG 138
|
| Min. Negotiated Rate |
$8,559.78 |
| Max. Negotiated Rate |
$11,262.88 |
| Rate for Payer: Aetna Medicare |
$9,010.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,262.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,262.88
|
| Rate for Payer: BCBS MAPPO |
$9,010.30
|
| Rate for Payer: BCN Medicare Advantage |
$9,010.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,010.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,010.30
|
| Rate for Payer: Mclaren Medicare |
$9,010.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,460.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,361.84
|
| Rate for Payer: PACE Medicare |
$8,559.78
|
| Rate for Payer: PACE SWMI |
$9,010.30
|
| Rate for Payer: PHP Commercial |
$9,911.33
|
| Rate for Payer: PHP Medicare Advantage |
$9,010.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,115.59
|
| Rate for Payer: Priority Health Medicare |
$9,010.30
|
| Rate for Payer: Priority Health Narrow Network |
$8,892.47
|
| Rate for Payer: Railroad Medicare Medicare |
$9,010.30
|
| Rate for Payer: UHC Medicare Advantage |
$9,280.61
|
| Rate for Payer: VA VA |
$9,010.30
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.92
|
|
|
Service Code
|
NDC 0781-7135-93
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.74 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$102.53
|
| Rate for Payer: ASR ASR |
$110.50
|
| Rate for Payer: BCBS Trust/PPO |
$88.32
|
| Rate for Payer: BCN Commercial |
$88.32
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$107.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.14
|
| Rate for Payer: Healthscope Commercial |
$113.92
|
| Rate for Payer: Healthscope Whirlpool |
$110.50
|
| Rate for Payer: Mclaren Commercial |
$102.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.25
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$566.09
|
|
|
Service Code
|
NDC 0065-4013-03
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$396.26 |
| Max. Negotiated Rate |
$566.09 |
| Rate for Payer: Aetna Commercial |
$509.48
|
| Rate for Payer: ASR ASR |
$549.11
|
| Rate for Payer: BCBS Trust/PPO |
$438.89
|
| Rate for Payer: BCN Commercial |
$438.89
|
| Rate for Payer: Cash Price |
$452.87
|
| Rate for Payer: Cofinity Commercial |
$532.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.87
|
| Rate for Payer: Healthscope Commercial |
$566.09
|
| Rate for Payer: Healthscope Whirlpool |
$549.11
|
| Rate for Payer: Mclaren Commercial |
$509.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$481.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$396.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.16
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$61.46
|
|
|
Service Code
|
NDC 68180-422-01
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.02 |
| Max. Negotiated Rate |
$61.46 |
| Rate for Payer: Aetna Commercial |
$55.31
|
| Rate for Payer: ASR ASR |
$59.62
|
| Rate for Payer: BCBS Trust/PPO |
$47.65
|
| Rate for Payer: BCN Commercial |
$47.65
|
| Rate for Payer: Cash Price |
$49.17
|
| Rate for Payer: Cofinity Commercial |
$57.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.17
|
| Rate for Payer: Healthscope Commercial |
$61.46
|
| Rate for Payer: Healthscope Whirlpool |
$59.62
|
| Rate for Payer: Mclaren Commercial |
$55.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.08
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862-840-03
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.27 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$98.06
|
| Rate for Payer: ASR ASR |
$105.69
|
| Rate for Payer: BCBS Trust/PPO |
$84.48
|
| Rate for Payer: BCN Commercial |
$84.48
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$102.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$108.96
|
| Rate for Payer: Healthscope Whirlpool |
$105.69
|
| Rate for Payer: Mclaren Commercial |
$98.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$61.50
|
|
|
Service Code
|
NDC 60505-0582-4
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$61.50 |
| Rate for Payer: Aetna Commercial |
$55.35
|
| Rate for Payer: ASR ASR |
$59.66
|
| Rate for Payer: BCBS Trust/PPO |
$47.68
|
| Rate for Payer: BCN Commercial |
$47.68
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cofinity Commercial |
$57.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.20
|
| Rate for Payer: Healthscope Commercial |
$61.50
|
| Rate for Payer: Healthscope Whirlpool |
$59.66
|
| Rate for Payer: Mclaren Commercial |
$55.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.12
|
|
