|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 51672201302
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.44
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.75
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE SWMI |
$2.75
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: PHP Medicare Advantage |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO |
$9.57
|
| Rate for Payer: Priority Health Medicare |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.37
|
| Rate for Payer: Railroad Medicare Medicare |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$9.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.75
|
| Rate for Payer: UHC Exchange |
$2.75
|
| Rate for Payer: UHC Medicare Advantage |
$2.75
|
| Rate for Payer: VA VA |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 51672201302
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCN Commercial |
$8.50
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health HMO/PPO |
$9.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$9.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health HMO/PPO |
$6.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC Core |
$6.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.47
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$6.14
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: PACE Senior Care Partners |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health HMO/PPO |
$6.87
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.29
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC Core |
$6.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.98
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UHC Medicare Advantage |
$1.98
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna Commercial |
$82.94
|
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.65
|
| Rate for Payer: BCBS Trust/PPO |
$80.28
|
| Rate for Payer: BCN Commercial |
$75.41
|
| Rate for Payer: BCN Commercial |
$76.00
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.68
|
| Rate for Payer: Cofinity Commercial |
$84.58
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.60
|
| Rate for Payer: Nomi Health Commercial |
$80.02
|
| Rate for Payer: Nomi Health Commercial |
$80.65
|
| Rate for Payer: PHP Commercial |
$82.94
|
| Rate for Payer: PHP Commercial |
$83.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: Priority Health HMO/PPO |
$85.56
|
| Rate for Payer: Priority Health HMO/PPO |
$84.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.55
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Core |
$82.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.76
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$98.35
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.36 |
| Max. Negotiated Rate |
$88.52 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Commercial |
$82.94
|
| Rate for Payer: Aetna Medicare |
$25.57
|
| Rate for Payer: Aetna Medicare |
$25.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.49
|
| Rate for Payer: BCBS Complete |
$39.03
|
| Rate for Payer: BCBS Complete |
$39.34
|
| Rate for Payer: BCBS MAPPO |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$24.59
|
| Rate for Payer: BCBS Trust/PPO |
$80.85
|
| Rate for Payer: BCBS Trust/PPO |
$80.22
|
| Rate for Payer: BCN Commercial |
$76.47
|
| Rate for Payer: BCN Commercial |
$75.87
|
| Rate for Payer: BCN Medicare Advantage |
$24.59
|
| Rate for Payer: BCN Medicare Advantage |
$24.40
|
| Rate for Payer: Cash Price |
$78.68
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Cofinity Commercial |
$84.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.59
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$80.65
|
| Rate for Payer: Nomi Health Commercial |
$80.02
|
| Rate for Payer: PACE Senior Care Partners |
$23.36
|
| Rate for Payer: PACE Senior Care Partners |
$23.18
|
| Rate for Payer: PACE SWMI |
$24.59
|
| Rate for Payer: PACE SWMI |
$24.40
|
| Rate for Payer: PHP Commercial |
$83.60
|
| Rate for Payer: PHP Commercial |
$82.94
|
| Rate for Payer: PHP Medicare Advantage |
$24.40
|
| Rate for Payer: PHP Medicare Advantage |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: Priority Health HMO/PPO |
$84.89
|
| Rate for Payer: Priority Health HMO/PPO |
$85.56
|
| Rate for Payer: Priority Health Medicare |
$24.83
|
| Rate for Payer: Priority Health Medicare |
$24.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.38
|
| Rate for Payer: Railroad Medicare Medicare |
$24.40
|
| Rate for Payer: Railroad Medicare Medicare |
$24.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.55
|
| Rate for Payer: UHC Core |
$82.12
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.40
|
| Rate for Payer: UHC Exchange |
$24.40
|
| Rate for Payer: UHC Exchange |
$24.59
|
| Rate for Payer: UHC Medicare Advantage |
$24.40
|
| Rate for Payer: UHC Medicare Advantage |
$24.59
|
| Rate for Payer: VA VA |
$24.40
|
| Rate for Payer: VA VA |
$24.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.18
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$12.57
|
| Rate for Payer: BCBS Trust/PPO |
$11.49
|
| Rate for Payer: BCN Commercial |
$12.74
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.13
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.20
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: Nomi Health Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health HMO/PPO |
$14.34
|
| Rate for Payer: Priority Health HMO/PPO |
$18.63
|
| Rate for Payer: Priority Health HMO/PPO |
$12.24
|
| Rate for Payer: Priority Health HMO/PPO |
$13.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.50
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Core |
$17.88
|
| Rate for Payer: UHC Core |
$12.86
|
| Rate for Payer: UHC Core |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Aetna Medicare |
$4.28
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.69
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$5.35
|
| Rate for Payer: BCBS MAPPO |
$4.12
|
| Rate for Payer: BCBS Trust/PPO |
$12.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$13.55
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: BCN Commercial |
$12.81
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.85
|
| Rate for Payer: BCN Medicare Advantage |
$5.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.12
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.12
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.62
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.20
|
| Rate for Payer: Nomi Health Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$17.56
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: PACE Senior Care Partners |
$3.66
|
| Rate for Payer: PACE Senior Care Partners |
$5.08
|
| Rate for Payer: PACE Senior Care Partners |
$3.91
|
| Rate for Payer: PACE Senior Care Partners |
$3.34
|
| Rate for Payer: PACE SWMI |
$5.35
|
| Rate for Payer: PACE SWMI |
$4.12
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.85
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Medicare Advantage |
$5.35
|
| Rate for Payer: PHP Medicare Advantage |
$3.85
|
| Rate for Payer: PHP Medicare Advantage |
$4.12
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health HMO/PPO |
$18.63
|
| Rate for Payer: Priority Health HMO/PPO |
$13.40
|
| Rate for Payer: Priority Health HMO/PPO |
$14.34
|
| Rate for Payer: Priority Health HMO/PPO |
$12.24
|
| Rate for Payer: Priority Health Medicare |
$5.41
|
| Rate for Payer: Priority Health Medicare |
$3.89
|
| Rate for Payer: Priority Health Medicare |
$4.16
|
| Rate for Payer: Priority Health Medicare |
$3.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.43
|
| Rate for Payer: Railroad Medicare Medicare |
$4.12
|
| Rate for Payer: Railroad Medicare Medicare |
$3.85
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.55
|
| Rate for Payer: UHC Core |
$11.75
|
| Rate for Payer: UHC Core |
$17.88
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Core |
$12.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.12
|
| Rate for Payer: UHC Exchange |
$3.52
|
| Rate for Payer: UHC Exchange |
$3.85
|
| Rate for Payer: UHC Exchange |
$4.12
|
| Rate for Payer: UHC Exchange |
$5.35
|
| Rate for Payer: UHC Medicare Advantage |
$5.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.12
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.85
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$5.35
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.85
|
| Rate for Payer: VA VA |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$17.06
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$18.82
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Aetna Medicare |
$8.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.99
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$4.26
|
| Rate for Payer: BCBS MAPPO |
$5.47
|
| Rate for Payer: BCBS MAPPO |
$7.99
|
| Rate for Payer: BCBS MAPPO |
$5.54
|
| Rate for Payer: BCBS Trust/PPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCBS Trust/PPO |
$18.20
|
| Rate for Payer: BCBS Trust/PPO |
$14.03
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$13.26
|
| Rate for Payer: BCN Commercial |
$24.86
|
| Rate for Payer: BCN Medicare Advantage |
$4.26
|
| Rate for Payer: BCN Medicare Advantage |
$5.47
|
| Rate for Payer: BCN Medicare Advantage |
$7.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.54
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$19.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.54
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.60
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.39
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$18.15
|
| Rate for Payer: Nomi Health Commercial |
$13.99
|
| Rate for Payer: PACE Senior Care Partners |
$5.19
|
| Rate for Payer: PACE Senior Care Partners |
$7.59
|
| Rate for Payer: PACE Senior Care Partners |
$5.26
|
| Rate for Payer: PACE Senior Care Partners |
$4.05
|
| Rate for Payer: PACE SWMI |
$7.99
|
| Rate for Payer: PACE SWMI |
$5.54
|
| Rate for Payer: PACE SWMI |
$4.26
|
| Rate for Payer: PACE SWMI |
$5.47
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$18.82
|
| Rate for Payer: PHP Medicare Advantage |
$7.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.47
|
| Rate for Payer: PHP Medicare Advantage |
$5.54
|
| Rate for Payer: PHP Medicare Advantage |
$4.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health HMO/PPO |
$19.03
|
| Rate for Payer: Priority Health HMO/PPO |
$19.26
|
| Rate for Payer: Priority Health HMO/PPO |
$14.84
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Medicare |
$5.52
|
| Rate for Payer: Priority Health Medicare |
$5.59
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.43
|
| Rate for Payer: Railroad Medicare Medicare |
$5.54
|
| Rate for Payer: Railroad Medicare Medicare |
$5.47
|
| Rate for Payer: Railroad Medicare Medicare |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.25
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$18.49
|
| Rate for Payer: UHC Core |
$18.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.54
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UHC Exchange |
$5.47
|
| Rate for Payer: UHC Exchange |
$5.54
|
| Rate for Payer: UHC Exchange |
$7.99
|
| Rate for Payer: UHC Medicare Advantage |
$7.99
|
| Rate for Payer: UHC Medicare Advantage |
$5.54
|
| Rate for Payer: UHC Medicare Advantage |
$4.26
|
| Rate for Payer: UHC Medicare Advantage |
$5.47
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$7.99
|
| Rate for Payer: VA VA |
$4.26
|
| Rate for Payer: VA VA |
$5.47
|
| Rate for Payer: VA VA |
$5.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$22.14
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$18.82
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| Rate for Payer: BCBS Trust/PPO |
$26.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Commercial |
$13.18
|
| Rate for Payer: BCN Commercial |
$24.71
|
| Rate for Payer: BCN Commercial |
$16.90
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$19.04
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.71
|
| 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: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Nomi Health Commercial |
$13.99
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$18.15
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$18.82
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.39
|
| Rate for Payer: Priority Health HMO/PPO |
$19.26
|
| Rate for Payer: Priority Health HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health HMO/PPO |
$14.84
|
| Rate for Payer: Priority Health HMO/PPO |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.48
|
| Rate for Payer: UHC Core |
$18.49
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$18.26
|
| Rate for Payer: UHC Core |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.60
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$26.96 |
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna Medicare |
$7.79
|
| Rate for Payer: Aetna Medicare |
$8.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.03
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$8.50
|
| Rate for Payer: BCBS MAPPO |
$5.63
|
| Rate for Payer: BCBS MAPPO |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.51
|
| Rate for Payer: BCBS Trust/PPO |
$27.96
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Commercial |
$26.44
|
| Rate for Payer: BCN Commercial |
$23.29
|
| Rate for Payer: BCN Medicare Advantage |
$8.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.63
|
| Rate for Payer: BCN Medicare Advantage |
$7.49
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.49
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.86
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: Nomi Health Commercial |
$27.89
|
| Rate for Payer: Nomi Health Commercial |
$18.46
|
| Rate for Payer: Nomi Health Commercial |
$24.56
|
| Rate for Payer: PACE Senior Care Partners |
$8.08
|
| Rate for Payer: PACE Senior Care Partners |
$5.35
|
| Rate for Payer: PACE Senior Care Partners |
$7.11
|
| Rate for Payer: PACE SWMI |
$5.63
|
| Rate for Payer: PACE SWMI |
$8.50
|
| Rate for Payer: PACE SWMI |
$7.49
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: PHP Commercial |
$28.91
|
| Rate for Payer: PHP Medicare Advantage |
$5.63
|
| Rate for Payer: PHP Medicare Advantage |
$7.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| 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 Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO |
$29.59
|
| Rate for Payer: Priority Health HMO/PPO |
$19.58
|
| Rate for Payer: Priority Health HMO/PPO |
$26.06
|
| Rate for Payer: Priority Health Medicare |
$7.56
|
| Rate for Payer: Priority Health Medicare |
$5.68
|
| Rate for Payer: Priority Health Medicare |
$8.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7.49
|
| Rate for Payer: Railroad Medicare Medicare |
$5.63
|
| Rate for Payer: Railroad Medicare Medicare |
$8.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Core |
$28.40
|
| Rate for Payer: UHC Core |
$18.80
|
| Rate for Payer: UHC Core |
$25.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.49
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$8.50
|
| Rate for Payer: UHC Exchange |
$7.49
|
| Rate for Payer: UHC Medicare Advantage |
$7.49
|
| Rate for Payer: UHC Medicare Advantage |
$5.63
|
| Rate for Payer: UHC Medicare Advantage |
$8.50
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$7.49
|
| Rate for Payer: VA VA |
$5.63
|
| Rate for Payer: VA VA |
$8.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$22.51
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.63 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: BCBS Trust/PPO |
$24.45
|
| Rate for Payer: BCBS Trust/PPO |
$18.37
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: BCN Commercial |
$26.28
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$19.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.96
|
| 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 |
$26.96
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: Nomi Health Commercial |
$18.46
|
| Rate for Payer: Nomi Health Commercial |
$24.56
|
| Rate for Payer: Nomi Health Commercial |
$27.89
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: PHP Commercial |
$28.91
|
| 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 Cigna Priority Health |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO |
$29.59
|
| Rate for Payer: Priority Health HMO/PPO |
$26.06
|
| Rate for Payer: Priority Health HMO/PPO |
$19.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Core |
$18.80
|
| Rate for Payer: UHC Core |
$28.40
|
| Rate for Payer: UHC Core |
$25.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.46
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna Medicare |
$70.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.77
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: BCBS MAPPO |
$67.81
|
| Rate for Payer: BCBS Trust/PPO |
$222.99
|
| Rate for Payer: BCN Commercial |
$210.90
|
| Rate for Payer: BCN Medicare Advantage |
$67.81
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.81
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.42
|
| Rate for Payer: PACE Senior Care Partners |
$64.42
|
| Rate for Payer: PACE SWMI |
$67.81
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: PHP Medicare Advantage |
$67.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health HMO/PPO |
$235.99
|
| Rate for Payer: Priority Health Medicare |
$68.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.74
|
| Rate for Payer: Railroad Medicare Medicare |
$67.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.70
|
| Rate for Payer: UHC Core |
$226.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.81
|
| Rate for Payer: UHC Exchange |
$67.81
|
| Rate for Payer: UHC Medicare Advantage |
$67.81
|
| Rate for Payer: VA VA |
$67.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: BCBS Trust/PPO |
$221.42
|
| Rate for Payer: BCN Commercial |
$209.62
|
| Rate for Payer: Cash Price |
$217.00
|
| 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: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.42
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health HMO/PPO |
$235.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.70
|
| Rate for Payer: UHC Core |
$226.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.03 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$50.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.56
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: BCBS MAPPO |
$48.45
|
| Rate for Payer: BCBS Trust/PPO |
$159.32
|
| Rate for Payer: BCN Commercial |
$150.68
|
| Rate for Payer: BCN Medicare Advantage |
$48.45
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.45
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Nomi Health Commercial |
$158.92
|
| Rate for Payer: PACE Senior Care Partners |
$46.03
|
| Rate for Payer: PACE SWMI |
$48.45
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: PHP Medicare Advantage |
$48.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health HMO/PPO |
$168.61
|
| Rate for Payer: Priority Health Medicare |
$48.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.85
|
| Rate for Payer: Railroad Medicare Medicare |
$48.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.54
|
| Rate for Payer: UHC Core |
$161.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.45
|
| Rate for Payer: UHC Exchange |
$48.45
|
| Rate for Payer: UHC Medicare Advantage |
$48.45
|
| Rate for Payer: VA VA |
$48.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.97 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: BCBS Trust/PPO |
$158.20
|
| Rate for Payer: BCN Commercial |
$149.77
|
| Rate for Payer: Cash Price |
$155.04
|
| 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: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Nomi Health Commercial |
$158.92
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health HMO/PPO |
$168.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.54
|
| Rate for Payer: UHC Core |
$161.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
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 |
$0.07 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.66
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$10.12
|
| Rate for Payer: BCBS Trust/PPO |
$33.30
|
| Rate for Payer: BCN Commercial |
$31.49
|
| Rate for Payer: BCN Medicare Advantage |
$10.12
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.63
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Nomi Health Commercial |
$33.21
|
| Rate for Payer: PACE Senior Care Partners |
$9.62
|
| Rate for Payer: PACE SWMI |
$10.12
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Medicare Advantage |
$10.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health HMO/PPO |
$35.24
|
| Rate for Payer: Priority Health Medicare |
$10.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.64
|
| Rate for Payer: UHC Core |
$33.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.12
|
| Rate for Payer: UHC Exchange |
$10.12
|
| Rate for Payer: UHC Medicare Advantage |
$10.12
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: BCBS Trust/PPO |
$33.06
|
| Rate for Payer: BCN Commercial |
$31.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Nomi Health Commercial |
$33.21
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health HMO/PPO |
$35.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.64
|
| Rate for Payer: UHC Core |
$33.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.91
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
117123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.22
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$4.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.37
|
| Rate for Payer: BCN Commercial |
$15.48
|
| Rate for Payer: BCN Medicare Advantage |
$4.98
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.98
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.23
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.92
|
| Rate for Payer: Nomi Health Commercial |
$16.33
|
| Rate for Payer: PACE Senior Care Partners |
$4.73
|
| Rate for Payer: PACE SWMI |
$4.98
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: PHP Medicare Advantage |
$4.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health HMO/PPO |
$17.32
|
| Rate for Payer: Priority Health Medicare |
$5.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.34
|
| Rate for Payer: Railroad Medicare Medicare |
$4.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$16.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.98
|
| Rate for Payer: UHC Exchange |
$4.98
|
| Rate for Payer: UHC Medicare Advantage |
$4.98
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$4.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.91
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
117123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.25
|
| Rate for Payer: BCN Commercial |
$15.39
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.92
|
| Rate for Payer: Nomi Health Commercial |
$16.33
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health HMO/PPO |
$17.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$16.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: BCBS Complete |
$0.07
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$11.57
|
| Rate for Payer: BCN Commercial |
$10.94
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Mclaren Medicaid |
$0.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.69
|
| Rate for Payer: Meridian Medicaid |
$0.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: PACE Senior Care Partners |
$3.34
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health HMO/PPO |
$12.24
|
| Rate for Payer: Priority Health Medicare |
$3.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$11.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Exchange |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHCCP Medicaid |
$0.07
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$11.49
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health HMO/PPO |
$12.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$484.32
|
|
|
Service Code
|
NDC 00904704661
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.03 |
| Max. Negotiated Rate |
$435.89 |
| Rate for Payer: Aetna Commercial |
$411.67
|
| Rate for Payer: Aetna Medicare |
$125.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.35
|
| Rate for Payer: BCBS Complete |
$193.73
|
| Rate for Payer: BCBS MAPPO |
$121.08
|
| Rate for Payer: BCBS Trust/PPO |
$398.16
|
| Rate for Payer: BCN Commercial |
$376.56
|
| Rate for Payer: BCN Medicare Advantage |
$121.08
|
| Rate for Payer: Cash Price |
$387.46
|
| Rate for Payer: Cofinity Commercial |
$416.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.08
|
| Rate for Payer: Healthscope Commercial |
$435.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.67
|
| Rate for Payer: Nomi Health Commercial |
$397.14
|
| Rate for Payer: PACE Senior Care Partners |
$115.03
|
| Rate for Payer: PACE SWMI |
$121.08
|
| Rate for Payer: PHP Commercial |
$411.67
|
| Rate for Payer: PHP Medicare Advantage |
$121.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.81
|
| Rate for Payer: Priority Health HMO/PPO |
$421.36
|
| Rate for Payer: Priority Health Medicare |
$122.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.49
|
| Rate for Payer: Railroad Medicare Medicare |
$121.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.20
|
| Rate for Payer: UHC Core |
$404.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.08
|
| Rate for Payer: UHC Exchange |
$121.08
|
| Rate for Payer: UHC Medicare Advantage |
$121.08
|
| Rate for Payer: VA VA |
$121.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.24
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$576.96
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.03 |
| Max. Negotiated Rate |
$519.26 |
| Rate for Payer: Aetna Commercial |
$490.42
|
| Rate for Payer: Aetna Medicare |
$150.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$180.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$180.30
|
| Rate for Payer: BCBS Complete |
$230.78
|
| Rate for Payer: BCBS MAPPO |
$144.24
|
| Rate for Payer: BCBS Trust/PPO |
$474.32
|
| Rate for Payer: BCN Commercial |
$448.59
|
| Rate for Payer: BCN Medicare Advantage |
$144.24
|
| Rate for Payer: Cash Price |
$461.57
|
| Rate for Payer: Cofinity Commercial |
$496.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.24
|
| Rate for Payer: Healthscope Commercial |
$519.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.42
|
| Rate for Payer: Nomi Health Commercial |
$473.11
|
| Rate for Payer: PACE Senior Care Partners |
$137.03
|
| Rate for Payer: PACE SWMI |
$144.24
|
| Rate for Payer: PHP Commercial |
$490.42
|
| Rate for Payer: PHP Medicare Advantage |
$144.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.02
|
| Rate for Payer: Priority Health HMO/PPO |
$501.96
|
| Rate for Payer: Priority Health Medicare |
$145.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.56
|
| Rate for Payer: Railroad Medicare Medicare |
$144.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.72
|
| Rate for Payer: UHC Core |
$481.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.24
|
| Rate for Payer: UHC Exchange |
$144.24
|
| Rate for Payer: UHC Medicare Advantage |
$144.24
|
| Rate for Payer: VA VA |
$144.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.72
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$576.96
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.02 |
| Max. Negotiated Rate |
$519.26 |
| Rate for Payer: Aetna Commercial |
$490.42
|
| Rate for Payer: BCBS Trust/PPO |
$470.97
|
| Rate for Payer: BCN Commercial |
$445.87
|
| Rate for Payer: Cash Price |
$461.57
|
| Rate for Payer: Cofinity Commercial |
$496.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.57
|
| Rate for Payer: Healthscope Commercial |
$519.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.42
|
| Rate for Payer: Nomi Health Commercial |
$473.11
|
| Rate for Payer: PHP Commercial |
$490.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.02
|
| Rate for Payer: Priority Health HMO/PPO |
$501.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$386.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.72
|
| Rate for Payer: UHC Core |
$481.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.72
|
|
