|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 68084040311
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: ASR Commercial |
$4.11
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| 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 Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$431.90
|
|
|
Service Code
|
NDC 00406831501
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.74 |
| Max. Negotiated Rate |
$431.90 |
| Rate for Payer: Aetna Commercial |
$388.71
|
| Rate for Payer: ASR ASR |
$418.94
|
| Rate for Payer: ASR Commercial |
$418.94
|
| Rate for Payer: BCBS Trust/PPO |
$351.96
|
| 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 Commercial |
$367.12
|
| Rate for Payer: Nomi Health Commercial |
$354.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.07
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$599.46 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: Aetna Commercial |
$830.02
|
| Rate for Payer: ASR ASR |
$894.58
|
| Rate for Payer: ASR Commercial |
$894.58
|
| Rate for Payer: BCBS Trust/PPO |
$751.54
|
| Rate for Payer: BCN Commercial |
$715.02
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$866.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Healthscope Commercial |
$922.25
|
| Rate for Payer: Healthscope Whirlpool |
$894.58
|
| Rate for Payer: Mclaren Commercial |
$830.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: Nomi Health Commercial |
$756.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$811.58
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.15 |
| Max. Negotiated Rate |
$511.00 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: ASR ASR |
$495.67
|
| Rate for Payer: ASR Commercial |
$495.67
|
| Rate for Payer: BCBS Trust/PPO |
$416.41
|
| Rate for Payer: BCN Commercial |
$396.18
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$480.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Healthscope Commercial |
$511.00
|
| Rate for Payer: Healthscope Whirlpool |
$495.67
|
| Rate for Payer: Mclaren Commercial |
$459.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.35
|
| Rate for Payer: Nomi Health Commercial |
$419.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$449.68
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$424.20
|
|
|
Service Code
|
NDC 68084040301
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$424.20 |
| Rate for Payer: Aetna Commercial |
$381.78
|
| Rate for Payer: Aetna Medicare |
$212.10
|
| Rate for Payer: ASR ASR |
$411.47
|
| Rate for Payer: ASR Commercial |
$411.47
|
| Rate for Payer: BCBS Complete |
$169.68
|
| Rate for Payer: BCBS Trust/PPO |
$347.38
|
| 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 Commercial |
$360.57
|
| Rate for Payer: Nomi Health Commercial |
$347.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.68
|
| Rate for Payer: Priority Health Narrow Network |
$297.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.30
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$424.20
|
|
|
Service Code
|
NDC 68084040301
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.73 |
| Max. Negotiated Rate |
$424.20 |
| Rate for Payer: Aetna Commercial |
$381.78
|
| Rate for Payer: ASR ASR |
$411.47
|
| Rate for Payer: ASR Commercial |
$411.47
|
| Rate for Payer: BCBS Trust/PPO |
$345.68
|
| 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 Commercial |
$360.57
|
| Rate for Payer: Nomi Health Commercial |
$347.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$373.30
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$788.90
|
|
|
Service Code
|
NDC 00406833062
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$512.78 |
| Max. Negotiated Rate |
$788.90 |
| Rate for Payer: Aetna Commercial |
$710.01
|
| Rate for Payer: ASR ASR |
$765.23
|
| Rate for Payer: ASR Commercial |
$765.23
|
| Rate for Payer: BCBS Trust/PPO |
$642.87
|
| Rate for Payer: BCN Commercial |
$611.63
|
| Rate for Payer: Cash Price |
$631.12
|
| Rate for Payer: Cofinity Commercial |
$741.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.12
|
| Rate for Payer: Healthscope Commercial |
$788.90
|
| Rate for Payer: Healthscope Whirlpool |
$765.23
|
| Rate for Payer: Mclaren Commercial |
$710.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.56
|
| Rate for Payer: Nomi Health Commercial |
$646.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.23
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$788.90
|
|
|
Service Code
|
NDC 00406833062
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.56 |
| Max. Negotiated Rate |
$788.90 |
| Rate for Payer: Aetna Commercial |
$710.01
|
| Rate for Payer: Aetna Medicare |
$394.45
|
| Rate for Payer: ASR ASR |
$765.23
|
| Rate for Payer: ASR Commercial |
$765.23
|
| Rate for Payer: BCBS Complete |
$315.56
|
| Rate for Payer: BCBS Trust/PPO |
$646.03
|
| Rate for Payer: BCN Commercial |
$611.63
|
| Rate for Payer: Cash Price |
$631.12
|
| Rate for Payer: Cofinity Commercial |
$741.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.12
|
| Rate for Payer: Healthscope Commercial |
$788.90
|
| Rate for Payer: Healthscope Whirlpool |
$765.23
|
| Rate for Payer: Mclaren Commercial |
$710.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.56
|
| Rate for Payer: Nomi Health Commercial |
$646.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.23
|
| Rate for Payer: Priority Health Narrow Network |
$553.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$694.23
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$717.50
|
|
|
Service Code
|
NDC 00904655861
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$466.38 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna Commercial |
$645.75
|
| Rate for Payer: ASR ASR |
$695.98
|
| Rate for Payer: ASR Commercial |
$695.98
|
| Rate for Payer: BCBS Trust/PPO |
$584.69
|
| Rate for Payer: BCN Commercial |
$556.28
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$674.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.00
|
| Rate for Payer: Healthscope Commercial |
$717.50
|
| Rate for Payer: Healthscope Whirlpool |
$695.98
|
| Rate for Payer: Mclaren Commercial |
$645.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.88
|
| Rate for Payer: Nomi Health Commercial |
$588.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$631.40
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$717.50
|
|
|
Service Code
|
NDC 00904655861
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$717.50 |
| Rate for Payer: Aetna Commercial |
$645.75
|
| Rate for Payer: Aetna Medicare |
$358.75
|
| Rate for Payer: ASR ASR |
$695.98
|
| Rate for Payer: ASR Commercial |
$695.98
|
| Rate for Payer: BCBS Complete |
$287.00
|
| Rate for Payer: BCBS Trust/PPO |
$587.56
|
| Rate for Payer: BCN Commercial |
$556.28
|
| Rate for Payer: Cash Price |
$574.00
|
| Rate for Payer: Cofinity Commercial |
$674.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$574.00
|
| Rate for Payer: Healthscope Commercial |
$717.50
|
| Rate for Payer: Healthscope Whirlpool |
$695.98
|
| Rate for Payer: Mclaren Commercial |
$645.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.88
|
| Rate for Payer: Nomi Health Commercial |
$588.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.67
|
| Rate for Payer: Priority Health Narrow Network |
$502.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$631.40
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$7.89
|
|
|
Service Code
|
NDC 00406833023
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.13 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: ASR ASR |
$7.65
|
| Rate for Payer: ASR Commercial |
$7.65
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Healthscope Whirlpool |
$7.65
|
| Rate for Payer: Mclaren Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.94
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$7.89
|
|
|
Service Code
|
NDC 00406833023
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: ASR ASR |
$7.65
|
| Rate for Payer: ASR Commercial |
$7.65
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.46
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Healthscope Whirlpool |
$7.65
|
| Rate for Payer: Mclaren Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.91
|
| Rate for Payer: Priority Health Narrow Network |
$5.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.94
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
OP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: ASR Commercial |
$11.27
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$9.30
|
| 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 Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.81
|
| Rate for Payer: Priority Health Narrow Network |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE INHALATION (VARIABLE DOSE)
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
300139
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: ASR Commercial |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| 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 Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$42.45
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Commercial |
$121.10
|
| Rate for Payer: Aetna Medicare |
$67.28
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR ASR |
$130.51
|
| Rate for Payer: ASR Commercial |
$130.51
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Complete |
$53.82
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCBS Trust/PPO |
$110.18
|
| Rate for Payer: BCN Commercial |
$104.32
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$134.55
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$130.51
|
| Rate for Payer: Mclaren Commercial |
$121.10
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Nomi Health Commercial |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.19
|
| Rate for Payer: Priority Health Narrow Network |
$8.15
|
| Rate for Payer: Priority Health Narrow Network |
$8.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Commercial |
$121.10
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR ASR |
$130.51
|
| Rate for Payer: ASR Commercial |
$130.51
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$109.64
|
| Rate for Payer: BCBS Trust/PPO |
$34.59
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: BCN Commercial |
$104.32
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cofinity Commercial |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$134.55
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$130.51
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Mclaren Commercial |
$121.10
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$110.33
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: ASR Commercial |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| 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 Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: ASR Commercial |
$11.27
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$9.30
|
| 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 Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.81
|
| Rate for Payer: Priority Health Narrow Network |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$48.79 |
| Rate for Payer: Aetna Commercial |
$43.91
|
| Rate for Payer: Aetna Medicare |
$24.40
|
| Rate for Payer: ASR ASR |
$47.33
|
| Rate for Payer: ASR Commercial |
$47.33
|
| Rate for Payer: BCBS Complete |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$39.95
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.03
|
| Rate for Payer: Healthscope Commercial |
$48.79
|
| Rate for Payer: Healthscope Whirlpool |
$47.33
|
| Rate for Payer: Mclaren Commercial |
$43.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$40.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.75
|
| Rate for Payer: Priority Health Narrow Network |
$34.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: Aetna Medicare |
$108.94
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: ASR Commercial |
$211.34
|
| Rate for Payer: BCBS Complete |
$87.15
|
| Rate for Payer: BCBS Trust/PPO |
$178.42
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$217.88
|
| Rate for Payer: Healthscope Whirlpool |
$211.34
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: Nomi Health Commercial |
$178.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.91
|
| Rate for Payer: Priority Health Narrow Network |
$152.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.92
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.05 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$102.53
|
| Rate for Payer: ASR ASR |
$110.50
|
| Rate for Payer: ASR Commercial |
$110.50
|
| Rate for Payer: BCBS Trust/PPO |
$92.83
|
| 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 Commercial |
$96.83
|
| Rate for Payer: Nomi Health Commercial |
$93.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.25
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.62 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: ASR Commercial |
$211.34
|
| Rate for Payer: BCBS Trust/PPO |
$177.55
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$217.88
|
| Rate for Payer: Healthscope Whirlpool |
$211.34
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: Nomi Health Commercial |
$178.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$48.79 |
| Rate for Payer: Aetna Commercial |
$43.91
|
| Rate for Payer: ASR ASR |
$47.33
|
| Rate for Payer: ASR Commercial |
$47.33
|
| Rate for Payer: BCBS Trust/PPO |
$39.76
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.03
|
| Rate for Payer: Healthscope Commercial |
$48.79
|
| Rate for Payer: Healthscope Whirlpool |
$47.33
|
| Rate for Payer: Mclaren Commercial |
$43.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$40.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$98.06
|
| Rate for Payer: ASR ASR |
$105.69
|
| Rate for Payer: ASR Commercial |
$105.69
|
| Rate for Payer: BCBS Trust/PPO |
$88.79
|
| 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 Commercial |
$92.62
|
| Rate for Payer: Nomi Health Commercial |
$89.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.92
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$102.53
|
| Rate for Payer: Aetna Medicare |
$56.96
|
| Rate for Payer: ASR ASR |
$110.50
|
| Rate for Payer: ASR Commercial |
$110.50
|
| Rate for Payer: BCBS Complete |
$45.57
|
| Rate for Payer: BCBS Trust/PPO |
$93.29
|
| 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 Commercial |
$96.83
|
| Rate for Payer: Nomi Health Commercial |
$93.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.82
|
| Rate for Payer: Priority Health Narrow Network |
$79.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.25
|
|
