|
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 |
$16.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.79
|
| 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 |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.61
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$22.51
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.35 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Commercial |
$25.46
|
| Rate for Payer: Aetna Medicare |
$8.84
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna Medicare |
$7.79
|
| 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 |
$7.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.63
|
| Rate for Payer: BCBS Complete |
$11.98
|
| Rate for Payer: BCBS Complete |
$9.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| 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 |
$23.29
|
| Rate for Payer: BCN Commercial |
$26.44
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Medicare Advantage |
$5.63
|
| Rate for Payer: BCN Medicare Advantage |
$7.49
|
| Rate for Payer: BCN Medicare Advantage |
$8.50
|
| Rate for Payer: Cash Price |
$23.96
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cash Price |
$18.01
|
| 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 |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.63
|
| Rate for Payer: Healthscope Commercial |
$26.95
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| 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 |
$7.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.13
|
| 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 |
$7.49
|
| Rate for Payer: PACE SWMI |
$5.63
|
| Rate for Payer: PACE SWMI |
$8.50
|
| Rate for Payer: PHP Commercial |
$28.91
|
| Rate for Payer: PHP Commercial |
$25.46
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: PHP Medicare Advantage |
$7.49
|
| Rate for Payer: PHP Medicare Advantage |
$8.50
|
| Rate for Payer: PHP Medicare Advantage |
$5.63
|
| 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 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 |
$5.68
|
| Rate for Payer: Priority Health Medicare |
$8.59
|
| Rate for Payer: Priority Health Medicare |
$7.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.08
|
| Rate for Payer: Railroad Medicare Medicare |
$7.49
|
| Rate for Payer: Railroad Medicare Medicare |
$8.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Core |
$28.40
|
| Rate for Payer: UHC Core |
$25.01
|
| Rate for Payer: UHC Core |
$18.80
|
| 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 |
$7.49
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Exchange |
$8.50
|
| Rate for Payer: UHC Medicare Advantage |
$5.63
|
| Rate for Payer: UHC Medicare Advantage |
$7.49
|
| Rate for Payer: UHC Medicare Advantage |
$8.50
|
| Rate for Payer: VA VA |
$7.49
|
| Rate for Payer: VA VA |
$8.50
|
| Rate for Payer: VA VA |
$5.63
|
| 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/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 |
$26.95
|
| 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 |
$70.53
|
| 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 |
$222.43
|
| 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 |
$222.43
|
| 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
|
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 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 (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 |
$35.23
|
| 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) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.62 |
| 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 |
$16.20
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.63
|
| 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 Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health HMO/PPO |
$35.23
|
| 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: VA VA |
$10.12
|
| 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 |
$4.73 |
| 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 |
$7.96
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.23
|
| 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 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: 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 |
$3.34 |
| 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 |
$5.63
|
| 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.69
|
| 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 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: 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
|
IP
|
$576.96
|
|
|
Service Code
|
NDC 68084026901
|
| 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
|
|
|
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
|
|
|
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
|
$484.32
|
|
|
Service Code
|
NDC 00904704661
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.81 |
| Max. Negotiated Rate |
$435.89 |
| Rate for Payer: Aetna Commercial |
$411.67
|
| Rate for Payer: BCBS Trust/PPO |
$395.35
|
| Rate for Payer: BCN Commercial |
$374.28
|
| 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: Healthscope Commercial |
$435.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.67
|
| Rate for Payer: Nomi Health Commercial |
$397.14
|
| Rate for Payer: PHP Commercial |
$411.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.81
|
| Rate for Payer: Priority Health HMO/PPO |
$421.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.20
|
| Rate for Payer: UHC Core |
$404.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.24
|
|
|
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 68084026901
|
| 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
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
OP
|
$2,128.29
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$505.47 |
| Max. Negotiated Rate |
$1,915.46 |
| Rate for Payer: Aetna Commercial |
$1,809.05
|
| Rate for Payer: Aetna Commercial |
$1,726.58
|
| Rate for Payer: Aetna Medicare |
$553.36
|
| Rate for Payer: Aetna Medicare |
$528.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$634.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$665.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$665.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$634.77
|
| Rate for Payer: BCBS Complete |
$812.51
|
| Rate for Payer: BCBS Complete |
$851.32
|
| Rate for Payer: BCBS MAPPO |
$507.82
|
| Rate for Payer: BCBS MAPPO |
$532.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.91
|
| Rate for Payer: BCN Commercial |
$1,654.75
|
| Rate for Payer: BCN Commercial |
$1,579.31
|
| Rate for Payer: BCN Medicare Advantage |
$532.07
|
| Rate for Payer: BCN Medicare Advantage |
$507.82
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cash Price |
$1,625.02
|
| Rate for Payer: Cofinity Commercial |
$1,746.89
|
| Rate for Payer: Cofinity Commercial |
$1,830.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$507.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$532.07
|
| Rate for Payer: Healthscope Commercial |
$1,828.14
|
| Rate for Payer: Healthscope Commercial |
$1,915.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$583.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$611.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.58
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: Nomi Health Commercial |
$1,665.64
|
| Rate for Payer: PACE Senior Care Partners |
$505.47
|
| Rate for Payer: PACE Senior Care Partners |
$482.43
|
| Rate for Payer: PACE SWMI |
$532.07
|
| Rate for Payer: PACE SWMI |
$507.82
|
| Rate for Payer: PHP Commercial |
$1,809.05
|
| Rate for Payer: PHP Commercial |
$1,726.58
|
| Rate for Payer: PHP Medicare Advantage |
$507.82
|
| Rate for Payer: PHP Medicare Advantage |
$532.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.33
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,851.61
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Medicare |
$512.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,360.95
|
| Rate for Payer: Railroad Medicare Medicare |
$507.82
|
| Rate for Payer: Railroad Medicare Medicare |
$532.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.90
|
| Rate for Payer: UHC Core |
$1,777.12
|
| Rate for Payer: UHC Core |
$1,696.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$532.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$507.82
|
| Rate for Payer: UHC Exchange |
$507.82
|
| Rate for Payer: UHC Exchange |
$532.07
|
| Rate for Payer: UHC Medicare Advantage |
$507.82
|
| Rate for Payer: UHC Medicare Advantage |
$532.07
|
| Rate for Payer: VA VA |
$507.82
|
| Rate for Payer: VA VA |
$532.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,596.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.45
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
IP
|
$2,031.27
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,320.33 |
| Max. Negotiated Rate |
$1,828.14 |
| Rate for Payer: Aetna Commercial |
$1,726.58
|
| Rate for Payer: Aetna Commercial |
$1,809.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,658.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.32
|
| Rate for Payer: BCN Commercial |
$1,569.77
|
| Rate for Payer: BCN Commercial |
$1,644.74
|
| Rate for Payer: Cash Price |
$1,625.02
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cofinity Commercial |
$1,830.33
|
| Rate for Payer: Cofinity Commercial |
$1,746.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.02
|
| Rate for Payer: Healthscope Commercial |
$1,828.14
|
| Rate for Payer: Healthscope Commercial |
$1,915.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.05
|
| Rate for Payer: Nomi Health Commercial |
$1,665.64
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: PHP Commercial |
$1,726.58
|
| Rate for Payer: PHP Commercial |
$1,809.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.33
|
| Rate for Payer: Priority Health HMO/PPO |
$1,851.61
|
| Rate for Payer: Priority Health HMO/PPO |
$1,767.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,360.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,425.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.90
|
| Rate for Payer: UHC Core |
$1,696.11
|
| Rate for Payer: UHC Core |
$1,777.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,596.22
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$348.96
|
|
|
Service Code
|
NDC 00904693961
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.88 |
| Max. Negotiated Rate |
$314.06 |
| Rate for Payer: Aetna Commercial |
$296.62
|
| Rate for Payer: Aetna Medicare |
$90.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$109.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$109.05
|
| Rate for Payer: BCBS Complete |
$139.58
|
| Rate for Payer: BCBS MAPPO |
$87.24
|
| Rate for Payer: BCBS Trust/PPO |
$286.88
|
| Rate for Payer: BCN Commercial |
$271.32
|
| Rate for Payer: BCN Medicare Advantage |
$87.24
|
| Rate for Payer: Cash Price |
$279.17
|
| Rate for Payer: Cofinity Commercial |
$300.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.24
|
| Rate for Payer: Healthscope Commercial |
$314.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.62
|
| Rate for Payer: Nomi Health Commercial |
$286.15
|
| Rate for Payer: PACE Senior Care Partners |
$82.88
|
| Rate for Payer: PACE SWMI |
$87.24
|
| Rate for Payer: PHP Commercial |
$296.62
|
| Rate for Payer: PHP Medicare Advantage |
$87.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.82
|
| Rate for Payer: Priority Health HMO/PPO |
$303.60
|
| Rate for Payer: Priority Health Medicare |
$88.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.80
|
| Rate for Payer: Railroad Medicare Medicare |
$87.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.08
|
| Rate for Payer: UHC Core |
$291.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.24
|
| Rate for Payer: UHC Exchange |
$87.24
|
| Rate for Payer: UHC Medicare Advantage |
$87.24
|
| Rate for Payer: VA VA |
$87.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.72
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$250.08
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.39 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna Medicare |
$65.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.15
|
| Rate for Payer: BCBS Complete |
$100.03
|
| Rate for Payer: BCBS MAPPO |
$62.52
|
| Rate for Payer: BCBS Trust/PPO |
$205.59
|
| Rate for Payer: BCN Commercial |
$194.44
|
| Rate for Payer: BCN Medicare Advantage |
$62.52
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.52
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Nomi Health Commercial |
$205.07
|
| Rate for Payer: PACE Senior Care Partners |
$59.39
|
| Rate for Payer: PACE SWMI |
$62.52
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: PHP Medicare Advantage |
$62.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health HMO/PPO |
$217.57
|
| Rate for Payer: Priority Health Medicare |
$63.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.55
|
| Rate for Payer: Railroad Medicare Medicare |
$62.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.07
|
| Rate for Payer: UHC Core |
$208.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.52
|
| Rate for Payer: UHC Exchange |
$62.52
|
| Rate for Payer: UHC Medicare Advantage |
$62.52
|
| Rate for Payer: VA VA |
$62.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: BCBS Trust/PPO |
$204.14
|
| Rate for Payer: BCN Commercial |
$193.26
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: Nomi Health Commercial |
$205.07
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health HMO/PPO |
$217.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.07
|
| Rate for Payer: UHC Core |
$208.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$348.96
|
|
|
Service Code
|
NDC 00904693961
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.82 |
| Max. Negotiated Rate |
$314.06 |
| Rate for Payer: Aetna Commercial |
$296.62
|
| Rate for Payer: BCBS Trust/PPO |
$284.86
|
| Rate for Payer: BCN Commercial |
$269.68
|
| Rate for Payer: Cash Price |
$279.17
|
| Rate for Payer: Cofinity Commercial |
$300.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$279.17
|
| Rate for Payer: Healthscope Commercial |
$314.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$261.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.62
|
| Rate for Payer: Nomi Health Commercial |
$286.15
|
| Rate for Payer: PHP Commercial |
$296.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.82
|
| Rate for Payer: Priority Health HMO/PPO |
$303.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.08
|
| Rate for Payer: UHC Core |
$291.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$261.72
|
|
