|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$31.97
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: Priority Health SBD |
$20.14
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$31.97
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna Medicare |
$15.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: Priority Health SBD |
$20.14
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$34.01
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$30.61 |
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.11
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$19.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.21
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: PHP Commercial |
$28.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.63
|
| Rate for Payer: Priority Health SBD |
$21.43
|
| Rate for Payer: Priority Health SBD |
$14.18
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$34.01
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$30.61 |
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna Medicare |
$11.26
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.11
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS Complete |
$9.00
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$19.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.21
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: PHP Commercial |
$28.91
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.11
|
| Rate for Payer: Priority Health SBD |
$21.43
|
| Rate for Payer: Priority Health SBD |
$14.18
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.50 |
| 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 Commercial |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.88
|
| 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: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health SBD |
$170.89
|
|
|
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 Commercial |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.88
|
| 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: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health SBD |
$170.89
|
|
|
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 Commercial |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.54
|
| 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: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.43
|
| Rate for Payer: Priority Health SBD |
$165.19
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$262.20
|
|
|
Service Code
|
NDC 00054026424
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.88 |
| 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 Commercial |
$183.54
|
| Rate for Payer: Cofinity Commercial |
$225.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.54
|
| 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: PHP Commercial |
$222.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.43
|
| Rate for Payer: Priority Health SBD |
$165.19
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.52 |
| 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 Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| 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: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
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 Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| 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: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
|
|
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 |
$15.68 |
| 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) |
$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: Cash Price |
$89.00
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cofinity Commercial |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.88
|
| 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: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| Rate for Payer: Priority Health SBD |
$24.70
|
| Rate for Payer: Priority Health SBD |
$70.09
|
|
|
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) |
$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 Commercial |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.88
|
| 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: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.31
|
| 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
|
OP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
190317
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.68 |
| 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 |
$15.68
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| 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 |
$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: PHP Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| 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
|
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 Commercial |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.88
|
| 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: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.31
|
| 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 (BBC)
|
Facility
|
OP
|
$39.20
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.68 |
| 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) |
$72.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.48
|
| Rate for Payer: BCBS Complete |
$44.50
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: Cash Price |
$31.36
|
| Rate for Payer: Cash Price |
$89.00
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$77.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| 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: PHP Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| 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 (BBC)
|
Facility
|
IP
|
$111.25
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301225
|
|
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 Commercial |
$77.88
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$95.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.88
|
| 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: Multiplan/Beech St/PHCS Commercial |
$94.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.32
|
| Rate for Payer: PHP Commercial |
$94.56
|
| Rate for Payer: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.31
|
| 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 |
$15.68 |
| 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 Commercial |
$27.44
|
| Rate for Payer: Cofinity Commercial |
$33.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| 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: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| Rate for Payer: Priority Health SBD |
$24.70
|
|
|
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 Commercial |
$33.71
|
| Rate for Payer: Cofinity Commercial |
$27.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.44
|
| 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: PHP Commercial |
$33.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.48
|
| Rate for Payer: Priority Health SBD |
$24.70
|
|
|
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 New Business (MI Preferred) |
$151.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$163.30
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$200.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$209.95
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$198.29
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.63
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$146.97
|
|
|
HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$198.29
|
| Rate for Payer: Aetna Medicare |
$116.64
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.63
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS Complete |
$93.31
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$163.30
|
| Rate for Payer: Cofinity Commercial |
$200.62
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$209.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.29
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$198.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health SBD |
$146.97
|
| Rate for Payer: Priority Health SBD |
$25.52
|
|
|
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 Commercial |
$69.31
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.31
|
| 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: PHP Commercial |
$84.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.36
|
| Rate for Payer: Priority Health SBD |
$62.38
|
|
|
HYDROMORPHONE (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
OP
|
$99.02
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
185738
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$84.17
|
| Rate for Payer: Aetna Medicare |
$49.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.36
|
| Rate for Payer: BCBS Complete |
$39.61
|
| Rate for Payer: Cash Price |
$79.22
|
| Rate for Payer: Cofinity Commercial |
$69.31
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.31
|
| 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: PHP Commercial |
$84.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.36
|
| Rate for Payer: Priority Health SBD |
$62.38
|
|
|
HYDROMORPHONE (PF) 2 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
163725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
|
|
HYDROMORPHONE (PF) 2 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
163725
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$26.95 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.47
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health SBD |
$18.87
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health SBD |
$8.86
|
|
