|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$258.62
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.10 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: ASR ASR |
$250.86
|
| Rate for Payer: ASR Commercial |
$250.86
|
| Rate for Payer: BCBS Trust/PPO |
$210.75
|
| Rate for Payer: BCN Commercial |
$200.51
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$258.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.86
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$213.41
|
|
|
Service Code
|
NDC 70954044410
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna Commercial |
$192.07
|
| Rate for Payer: ASR ASR |
$207.01
|
| Rate for Payer: ASR Commercial |
$207.01
|
| Rate for Payer: BCBS Trust/PPO |
$173.91
|
| Rate for Payer: BCN Commercial |
$165.46
|
| Rate for Payer: Cash Price |
$170.73
|
| Rate for Payer: Cofinity Commercial |
$200.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.73
|
| Rate for Payer: Healthscope Commercial |
$213.41
|
| Rate for Payer: Healthscope Whirlpool |
$207.01
|
| Rate for Payer: Mclaren Commercial |
$192.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.40
|
| Rate for Payer: Nomi Health Commercial |
$175.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.80
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.18 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$387.94
|
| Rate for Payer: ASR ASR |
$418.11
|
| Rate for Payer: ASR Commercial |
$418.11
|
| Rate for Payer: BCBS Trust/PPO |
$351.25
|
| Rate for Payer: BCN Commercial |
$334.19
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$405.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$431.04
|
| Rate for Payer: Healthscope Whirlpool |
$418.11
|
| Rate for Payer: Mclaren Commercial |
$387.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.32
|
|
|
MOLASSES
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$11.97
|
| Rate for Payer: ASR ASR |
$23.22
|
| Rate for Payer: ASR Commercial |
$23.22
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCN Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Healthscope Whirlpool |
$23.22
|
| Rate for Payer: Mclaren Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.98
|
| Rate for Payer: Priority Health Narrow Network |
$16.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.07
|
|
|
MOLASSES
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 00990000075
|
| Hospital Charge Code |
500563
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$23.94 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: ASR ASR |
$23.22
|
| Rate for Payer: ASR Commercial |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.51
|
| Rate for Payer: BCN Commercial |
$18.56
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
| Rate for Payer: Healthscope Commercial |
$23.94
|
| Rate for Payer: Healthscope Whirlpool |
$23.22
|
| Rate for Payer: Mclaren Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.07
|
|
|
MONALISA TOUCH, SERIES, UP TO 3 VISITS
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00561
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
|
|
MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00562
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
OP
|
$240.35
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.14 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Aetna Commercial |
$216.31
|
| Rate for Payer: Aetna Medicare |
$120.17
|
| Rate for Payer: ASR ASR |
$233.14
|
| Rate for Payer: ASR Commercial |
$233.14
|
| Rate for Payer: BCBS Complete |
$96.14
|
| Rate for Payer: BCBS Trust/PPO |
$196.82
|
| Rate for Payer: BCN Commercial |
$186.34
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$225.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$240.35
|
| Rate for Payer: Healthscope Whirlpool |
$233.14
|
| Rate for Payer: Mclaren Commercial |
$216.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.59
|
| Rate for Payer: Priority Health Narrow Network |
$168.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.51
|
|
|
MONTELUKAST 10 MG TABLET
|
Facility
|
IP
|
$240.35
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.23 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Aetna Commercial |
$216.31
|
| Rate for Payer: ASR ASR |
$233.14
|
| Rate for Payer: ASR Commercial |
$233.14
|
| Rate for Payer: BCBS Trust/PPO |
$195.86
|
| Rate for Payer: BCN Commercial |
$186.34
|
| Rate for Payer: Cash Price |
$192.28
|
| Rate for Payer: Cofinity Commercial |
$225.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.28
|
| Rate for Payer: Healthscope Commercial |
$240.35
|
| Rate for Payer: Healthscope Whirlpool |
$233.14
|
| Rate for Payer: Mclaren Commercial |
$216.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.30
|
| Rate for Payer: Nomi Health Commercial |
$197.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.51
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.46
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR Commercial |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.46
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Aetna Commercial |
$15.71
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: ASR ASR |
$16.94
|
| Rate for Payer: ASR Commercial |
$16.94
|
| Rate for Payer: BCBS Complete |
$6.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCN Commercial |
$13.54
|
| Rate for Payer: Cash Price |
$13.97
|
| Rate for Payer: Cofinity Commercial |
$16.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.97
|
| Rate for Payer: Healthscope Commercial |
$17.46
|
| Rate for Payer: Healthscope Whirlpool |
$16.94
|
| Rate for Payer: Mclaren Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.84
|
| Rate for Payer: Nomi Health Commercial |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.30
|
| Rate for Payer: Priority Health Narrow Network |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.36
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: ASR ASR |
$16.02
|
| Rate for Payer: ASR Commercial |
$16.02
|
| Rate for Payer: BCBS Trust/PPO |
$13.46
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Healthscope Whirlpool |
$16.02
|
| Rate for Payer: Mclaren Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$13.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.54
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$14.87
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: ASR ASR |
$16.02
|
| Rate for Payer: ASR Commercial |
$16.02
|
| Rate for Payer: BCBS Complete |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$15.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Healthscope Whirlpool |
$16.02
|
| Rate for Payer: Mclaren Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$13.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.47
|
| Rate for Payer: Priority Health Narrow Network |
$11.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.54
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$123.38
|
|
|
Service Code
|
NDC 00054023524
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: ASR ASR |
$119.68
|
| Rate for Payer: ASR Commercial |
$119.68
|
| Rate for Payer: BCBS Trust/PPO |
$100.54
|
| Rate for Payer: BCN Commercial |
$95.66
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$115.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Healthscope Whirlpool |
$119.68
|
| Rate for Payer: Mclaren Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$101.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.57
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$123.38
|
|
|
Service Code
|
NDC 00054023524
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Aetna Medicare |
$61.69
|
| Rate for Payer: ASR ASR |
$119.68
|
| Rate for Payer: ASR Commercial |
$119.68
|
| Rate for Payer: BCBS Complete |
$49.35
|
| Rate for Payer: BCBS Trust/PPO |
$101.04
|
| Rate for Payer: BCN Commercial |
$95.66
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$115.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Healthscope Whirlpool |
$119.68
|
| Rate for Payer: Mclaren Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: Nomi Health Commercial |
$101.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.11
|
| Rate for Payer: Priority Health Narrow Network |
$86.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.57
|
|
|
MORPHINE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$26.75
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: ASR ASR |
$25.95
|
| Rate for Payer: ASR Commercial |
$25.95
|
| Rate for Payer: BCBS Trust/PPO |
$21.80
|
| Rate for Payer: BCN Commercial |
$20.74
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$26.75
|
| Rate for Payer: Healthscope Whirlpool |
$25.95
|
| Rate for Payer: Mclaren Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.54
|
|
|
MORPHINE 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$26.75
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: ASR ASR |
$25.95
|
| Rate for Payer: ASR Commercial |
$25.95
|
| Rate for Payer: BCBS Complete |
$10.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.91
|
| Rate for Payer: BCN Commercial |
$20.74
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$26.75
|
| Rate for Payer: Healthscope Whirlpool |
$25.95
|
| Rate for Payer: Mclaren Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.44
|
| Rate for Payer: Priority Health Narrow Network |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.54
|
|
|
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 |
$20.02 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: ASR Commercial |
$29.88
|
| Rate for Payer: BCBS Trust/PPO |
$25.10
|
| 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 Commercial |
$26.18
|
| Rate for Payer: Nomi Health Commercial |
$25.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
|
|
MORPHINE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$30.80
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
186563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: ASR Commercial |
$29.88
|
| Rate for Payer: BCBS Complete |
$12.32
|
| Rate for Payer: BCBS Trust/PPO |
$25.22
|
| 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 Commercial |
$26.18
|
| Rate for Payer: Nomi Health Commercial |
$25.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.99
|
| Rate for Payer: Priority Health Narrow Network |
$21.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$26.75
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: ASR ASR |
$25.95
|
| Rate for Payer: ASR Commercial |
$25.95
|
| Rate for Payer: BCBS Trust/PPO |
$21.80
|
| Rate for Payer: BCN Commercial |
$20.74
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$26.75
|
| Rate for Payer: Healthscope Whirlpool |
$25.95
|
| Rate for Payer: Mclaren Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.54
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$26.75
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$26.75 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: ASR ASR |
$25.95
|
| Rate for Payer: ASR Commercial |
$25.95
|
| Rate for Payer: BCBS Complete |
$10.70
|
| Rate for Payer: BCBS Trust/PPO |
$21.91
|
| Rate for Payer: BCN Commercial |
$20.74
|
| Rate for Payer: Cash Price |
$21.40
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$26.75
|
| Rate for Payer: Healthscope Whirlpool |
$25.95
|
| Rate for Payer: Mclaren Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.74
|
| Rate for Payer: Nomi Health Commercial |
$21.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.44
|
| Rate for Payer: Priority Health Narrow Network |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.54
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$15.88
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$14.29
|
| Rate for Payer: Aetna Commercial |
$23.37
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR ASR |
$25.19
|
| Rate for Payer: ASR Commercial |
$25.19
|
| Rate for Payer: ASR Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: BCBS Complete |
$10.39
|
| Rate for Payer: BCBS Trust/PPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Whirlpool |
$15.40
|
| Rate for Payer: Healthscope Whirlpool |
$25.19
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Mclaren Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.50
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Nomi Health Commercial |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.75
|
| Rate for Payer: Priority Health Narrow Network |
$18.20
|
| Rate for Payer: Priority Health Narrow Network |
$11.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.97
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$25.97
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.88 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$23.37
|
| Rate for Payer: Aetna Commercial |
$14.29
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR ASR |
$25.19
|
| Rate for Payer: ASR Commercial |
$15.40
|
| Rate for Payer: ASR Commercial |
$25.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCBS Trust/PPO |
$21.16
|
| Rate for Payer: BCN Commercial |
$20.13
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cash Price |
$12.71
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Whirlpool |
$25.19
|
| Rate for Payer: Healthscope Whirlpool |
$15.40
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Mclaren Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.50
|
| Rate for Payer: Nomi Health Commercial |
$21.30
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.97
|
| 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
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: ASR Commercial |
$10.79
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.11
|
| Rate for Payer: BCN Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$11.12
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.74
|
| Rate for Payer: Priority Health Narrow Network |
$7.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.79
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$11.12 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: ASR ASR |
$10.79
|
| Rate for Payer: ASR Commercial |
$10.79
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCN Commercial |
$8.62
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$11.12
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Mclaren Commercial |
$10.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: Nomi Health Commercial |
$9.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.79
|
|
