|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.89 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.31
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Advantage |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.44
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health SBD |
$170.89
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna Medicare |
$135.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.31
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Advantage |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.44
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health SBD |
$170.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.31
|
| Rate for Payer: UHC Core |
$141.32
|
| Rate for Payer: UHC Exchange |
$106.60
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
NDC 00406324301
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Advantage |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health SBD |
$194.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.20
|
| Rate for Payer: UHC Core |
$160.47
|
| Rate for Payer: UHC Exchange |
$121.04
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
NDC 00406324301
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Advantage |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health SBD |
$194.04
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.09 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 60687059011
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.71
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.97
|
| Rate for Payer: UHC Core |
$100.97
|
| Rate for Payer: UHC Exchange |
$76.16
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00406324401
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Advantage |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.20
|
| Rate for Payer: UHC Core |
$101.96
|
| Rate for Payer: UHC Exchange |
$76.91
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 00054026424
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.04 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna Medicare |
$131.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: BCBS Complete |
$104.88
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.43
|
| Rate for Payer: UHC Core |
$136.61
|
| Rate for Payer: UHC Exchange |
$103.04
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$262.20
|
|
|
Service Code
|
NDC 00054026424
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.19 |
| Max. Negotiated Rate |
$235.98 |
| Rate for Payer: Aetna Commercial |
$222.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.43
|
| Rate for Payer: Cash Price |
$209.76
|
| Rate for Payer: Cofinity Advantage |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.76
|
| Rate for Payer: Healthscope Commercial |
$235.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.65
|
| Rate for Payer: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health SBD |
$165.19
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 60687059011
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.79
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Exchange |
$1.69
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$429.40
|
|
|
Service Code
|
NDC 60687059001
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.52 |
| Max. Negotiated Rate |
$386.46 |
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.11
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cofinity Advantage |
$300.58
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.05
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: Priority Health SBD |
$270.52
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$429.40
|
|
|
Service Code
|
NDC 60687059001
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$386.46 |
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Medicare |
$214.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.11
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cofinity Advantage |
$300.58
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.05
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: Priority Health SBD |
$270.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.11
|
| Rate for Payer: UHC Core |
$223.72
|
| Rate for Payer: UHC Exchange |
$168.75
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00406324401
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Advantage |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.78
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
HYDROMORPHONE 50 MG/50 ML PCA IV SOLUTION
|
Facility
|
OP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$55.62
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
HYDROMORPHONE 50 MG/50 ML PCA IV SOLUTION
|
Facility
|
IP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: Priority Health SBD |
$70.09
|
|
|
HYDROMORPHONE AVERAGE 50 MG/50 ML PCA IV SOLUTION
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
190317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.09 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health SBD |
$24.70
|
|
|
HYDROMORPHONE AVERAGE 50 MG/50 ML PCA IV SOLUTION
|
Facility
|
OP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
190317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: Aetna Medicare |
$55.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
HYDROMORPHONE AVERAGE 50 MG/50 ML PCA IV SOLUTION (BBC)
|
Facility
|
OP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna Medicare |
$55.62
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: Priority Health SBD |
$70.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
HYDROMORPHONE AVERAGE 50 MG/50 ML PCA IV SOLUTION (BBC)
|
Facility
|
IP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Commercial |
$94.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Advantage |
$77.88
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.00
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: Healthscope Commercial |
$100.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: Priority Health SBD |
$70.09
|
|
|
HYDROMORPHONE INFUSION (IV PREMIX)
|
Facility
|
OP
|
$39.20
|
|
|
Service Code
|
NDC 09900001838
|
| Hospital Charge Code |
151075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.41 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.48
|
| Rate for Payer: UHC Core |
$20.42
|
| Rate for Payer: UHC Exchange |
$15.41
|
|
|
HYDROMORPHONE INFUSION (IV PREMIX)
|
Facility
|
IP
|
$39.20
|
|
|
Service Code
|
NDC 09900001838
|
| Hospital Charge Code |
151075
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Aetna Commercial |
$33.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Advantage |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$35.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.40
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health SBD |
$24.70
|
|
|
HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$233.28
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$58.76
|
| Rate for Payer: Aetna Medicare |
$116.64
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna Medicare |
$34.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.93
|
| Rate for Payer: BCBS Complete |
$27.65
|
| Rate for Payer: BCBS Complete |
$93.31
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Advantage |
$163.30
|
| Rate for Payer: Cofinity Advantage |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$200.62
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.62
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$209.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.85
|
| Rate for Payer: PHP Commercial |
$198.29
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$58.76
|
| Rate for Payer: Priority Health SBD |
$146.97
|
| Rate for Payer: Priority Health SBD |
$43.55
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$233.28
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$209.95 |
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$58.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.93
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Advantage |
$163.30
|
| Rate for Payer: Cofinity Advantage |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Cofinity Commercial |
$200.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.62
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$209.95
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.96
|
| Rate for Payer: PHP Commercial |
$198.29
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$58.76
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$146.97
|
| Rate for Payer: Priority Health SBD |
$43.55
|
|
|
HYDROMORPHONE (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
IP
|
$99.02
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
185738
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.38 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$84.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.36
|
| Rate for Payer: Cash Price |
$79.22
|
| Rate for Payer: Cofinity Advantage |
$69.31
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.22
|
| Rate for Payer: Healthscope Commercial |
$89.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.27
|
| Rate for Payer: PHP Commercial |
$84.17
|
| Rate for Payer: Priority Health SBD |
$62.38
|
|
