|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$512.34
|
|
|
Service Code
|
NDC 0574-7090-12
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.43 |
| Max. Negotiated Rate |
$461.11 |
| Rate for Payer: Aetna American Axle |
$333.02
|
| Rate for Payer: Aetna Commercial |
$435.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.02
|
| Rate for Payer: Cash Price |
$409.87
|
| Rate for Payer: Cofinity Commercial |
$358.64
|
| Rate for Payer: Cofinity Commercial |
$440.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.87
|
| Rate for Payer: Healthscope Commercial |
$461.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$358.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$384.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$435.49
|
| Rate for Payer: PHP Commercial |
$435.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$358.64
|
| Rate for Payer: Priority Health SBD |
$322.77
|
| Rate for Payer: UMR Bronson Commercial |
$225.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$384.26
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
NDC 0713-0503-06
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Aetna American Axle |
$25.72
|
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cofinity Commercial |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.63
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.70
|
| Rate for Payer: Priority Health SBD |
$24.93
|
| Rate for Payer: UMR Bronson Commercial |
$17.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.68
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3,225.66
|
|
|
Service Code
|
NDC 0713-0503-01
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,419.29 |
| Max. Negotiated Rate |
$2,903.09 |
| Rate for Payer: Aetna American Axle |
$2,096.68
|
| Rate for Payer: Aetna Commercial |
$2,741.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,096.68
|
| Rate for Payer: Cash Price |
$2,580.53
|
| Rate for Payer: Cofinity Commercial |
$2,257.96
|
| Rate for Payer: Cofinity Commercial |
$2,774.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,580.53
|
| Rate for Payer: Healthscope Commercial |
$2,903.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,257.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,419.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,741.81
|
| Rate for Payer: PHP Commercial |
$2,741.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,257.96
|
| Rate for Payer: Priority Health SBD |
$2,032.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,419.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,419.24
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$8.07
|
|
|
Service Code
|
NDC 0536-1277-80
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Aetna American Axle |
$5.25
|
| Rate for Payer: Aetna Commercial |
$6.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.25
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$7.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.86
|
| Rate for Payer: PHP Commercial |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.65
|
| Rate for Payer: Priority Health SBD |
$5.08
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.05
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
NDC 0574-0420-25
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna American Axle |
$191.81
|
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.81
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$250.83
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.56
|
| Rate for Payer: Priority Health SBD |
$185.91
|
| Rate for Payer: UMR Bronson Commercial |
$129.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.32
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
IP
|
$245.70
|
|
|
Service Code
|
NDC 38779-0009-4
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.11 |
| Max. Negotiated Rate |
$221.13 |
| Rate for Payer: Aetna American Axle |
$159.70
|
| Rate for Payer: Aetna Commercial |
$208.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.70
|
| Rate for Payer: Cash Price |
$196.56
|
| Rate for Payer: Cofinity Commercial |
$171.99
|
| Rate for Payer: Cofinity Commercial |
$211.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.56
|
| Rate for Payer: Healthscope Commercial |
$221.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.84
|
| Rate for Payer: PHP Commercial |
$208.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.99
|
| Rate for Payer: Priority Health SBD |
$154.79
|
| Rate for Payer: UMR Bronson Commercial |
$108.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.28
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$61.46
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$55.31 |
| Rate for Payer: Aetna American Axle |
$39.95
|
| Rate for Payer: Aetna Commercial |
$52.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.95
|
| Rate for Payer: Cash Price |
$49.17
|
| Rate for Payer: Cofinity Commercial |
$43.02
|
| Rate for Payer: Cofinity Commercial |
$52.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.17
|
| Rate for Payer: Healthscope Commercial |
$55.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.24
|
| Rate for Payer: PHP Commercial |
$52.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.02
|
| Rate for Payer: Priority Health SBD |
$38.72
|
| Rate for Payer: UMR Bronson Commercial |
$27.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.10
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$83.40
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.70 |
| Max. Negotiated Rate |
$75.06 |
| Rate for Payer: Aetna American Axle |
$54.21
|
| Rate for Payer: Aetna American Axle |
$54.87
|
| Rate for Payer: Aetna Commercial |
$70.89
|
| Rate for Payer: Aetna Commercial |
$71.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.21
|
| Rate for Payer: Cash Price |
$66.72
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cofinity Commercial |
$72.60
|
| Rate for Payer: Cofinity Commercial |
$71.72
|
| Rate for Payer: Cofinity Commercial |
$58.38
|
| Rate for Payer: Cofinity Commercial |
$59.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.72
|
| Rate for Payer: Healthscope Commercial |
$75.98
|
| Rate for Payer: Healthscope Commercial |
$75.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.89
|
| Rate for Payer: PHP Commercial |
$71.76
|
| Rate for Payer: PHP Commercial |
$70.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.09
|
| Rate for Payer: Priority Health SBD |
$52.54
|
| Rate for Payer: Priority Health SBD |
$53.18
|
| Rate for Payer: UMR Bronson Commercial |
$37.14
|
| Rate for Payer: UMR Bronson Commercial |
$36.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.32
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$83.40
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$75.06 |
| Rate for Payer: Aetna American Axle |
$54.21
|
| Rate for Payer: Aetna American Axle |
$54.87
|
| Rate for Payer: Aetna Commercial |
$71.76
|
| Rate for Payer: Aetna Commercial |
$70.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.87
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Complete |
$33.36
|
| Rate for Payer: BCBS Trust/PPO |
$57.66
|
| Rate for Payer: BCBS Trust/PPO |
$57.66
|
| Rate for Payer: Cash Price |
$66.72
|
| Rate for Payer: Cash Price |
$66.72
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cofinity Commercial |
$59.09
|
| Rate for Payer: Cofinity Commercial |
$71.72
|
| Rate for Payer: Cofinity Commercial |
$58.38
|
| Rate for Payer: Cofinity Commercial |
$72.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.72
|
| Rate for Payer: Healthscope Commercial |
$75.98
|
| Rate for Payer: Healthscope Commercial |
$75.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.76
|
| Rate for Payer: PHP Commercial |
$71.76
|
| Rate for Payer: PHP Commercial |
$70.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.09
|
| Rate for Payer: Priority Health SBD |
$53.18
|
| Rate for Payer: Priority Health SBD |
$52.54
|
| Rate for Payer: UMR Bronson Commercial |
$30.86
|
| Rate for Payer: UMR Bronson Commercial |
$31.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.55
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$155.22
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.30 |
| Max. Negotiated Rate |
$139.70 |
| Rate for Payer: Aetna American Axle |
$100.89
|
| Rate for Payer: Aetna American Axle |
$101.52
|
| Rate for Payer: Aetna Commercial |
$132.75
|
| Rate for Payer: Aetna Commercial |
$131.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.52
|
| Rate for Payer: Cash Price |
$124.18
|
| Rate for Payer: Cash Price |
$124.94
|
| Rate for Payer: Cofinity Commercial |
$134.31
|
| Rate for Payer: Cofinity Commercial |
$133.49
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Cofinity Commercial |
$109.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.18
|
| Rate for Payer: Healthscope Commercial |
$139.70
|
| Rate for Payer: Healthscope Commercial |
$140.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$131.94
|
| Rate for Payer: PHP Commercial |
$132.75
|
| Rate for Payer: PHP Commercial |
$131.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.33
|
| Rate for Payer: Priority Health SBD |
$97.79
|
| Rate for Payer: Priority Health SBD |
$98.39
|
| Rate for Payer: UMR Bronson Commercial |
$68.30
|
| Rate for Payer: UMR Bronson Commercial |
$68.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.14
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM
|
Facility
|
IP
|
$53.71
|
|
|
Service Code
|
NDC 51672-1290-1
|
| Hospital Charge Code |
10218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$48.34 |
| Rate for Payer: Aetna American Axle |
$34.91
|
| Rate for Payer: Aetna Commercial |
$45.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.91
|
| Rate for Payer: Cash Price |
$42.97
|
| Rate for Payer: Cofinity Commercial |
$46.19
|
| Rate for Payer: Cofinity Commercial |
$37.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.97
|
| Rate for Payer: Healthscope Commercial |
$48.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.65
|
| Rate for Payer: PHP Commercial |
$45.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.60
|
| Rate for Payer: Priority Health SBD |
$33.84
|
| Rate for Payer: UMR Bronson Commercial |
$23.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.28
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM
|
Facility
|
IP
|
$234.99
|
|
|
Service Code
|
NDC 45802-455-42
|
| Hospital Charge Code |
10218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$211.49 |
| Rate for Payer: Aetna American Axle |
$152.74
|
| Rate for Payer: Aetna Commercial |
$199.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.74
|
| Rate for Payer: Cash Price |
$187.99
|
| Rate for Payer: Cofinity Commercial |
$164.49
|
| Rate for Payer: Cofinity Commercial |
$202.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.99
|
| Rate for Payer: Healthscope Commercial |
$211.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$199.74
|
| Rate for Payer: PHP Commercial |
$199.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.49
|
| Rate for Payer: Priority Health SBD |
$148.04
|
| Rate for Payer: UMR Bronson Commercial |
$103.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.24
|
|
|
HYDROCORTISONE VALERATE 0.2 % TOPICAL CREAM
|
Facility
|
IP
|
$113.09
|
|
|
Service Code
|
NDC 51672-1290-6
|
| Hospital Charge Code |
10218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.76 |
| Max. Negotiated Rate |
$101.78 |
| Rate for Payer: Aetna American Axle |
$73.51
|
| Rate for Payer: Aetna Commercial |
$96.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.51
|
| Rate for Payer: Cash Price |
$90.47
|
| Rate for Payer: Cofinity Commercial |
$79.16
|
| Rate for Payer: Cofinity Commercial |
$97.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.47
|
| Rate for Payer: Healthscope Commercial |
$101.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.13
|
| Rate for Payer: PHP Commercial |
$96.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.16
|
| Rate for Payer: Priority Health SBD |
$71.25
|
| Rate for Payer: UMR Bronson Commercial |
$49.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.82
|
|
|
HYDROMORPHONE 0.2 MG/ML PEDIATRIC PCA IV SOLUTION 50 ML
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
301645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$21.41
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna American Axle |
$13.92
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| 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 |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| 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 |
$17.13
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.20
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
|
|
HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) ADULT AVERAGE PCA IV SOLUTION 50 ML
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
301640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna American Axle |
$50.70
|
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) ADULT TOLERANT PCA IV SOLUTION 50 ML
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
301641
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna American Axle |
$50.70
|
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$29.60
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.16
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$29.60
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna American Axle |
$10.41
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna Commercial |
$13.62
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$12.82
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$11.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Healthscope Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.85
|
| Rate for Payer: PHP Commercial |
$13.62
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health SBD |
$10.09
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: UMR Bronson Commercial |
$7.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$3,774.54
|
|
|
Service Code
|
NDC 0054-0386-63
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,660.80 |
| Max. Negotiated Rate |
$3,397.09 |
| Rate for Payer: Aetna American Axle |
$2,453.45
|
| Rate for Payer: Aetna Commercial |
$3,208.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,453.45
|
| Rate for Payer: Cash Price |
$3,019.63
|
| Rate for Payer: Cofinity Commercial |
$2,642.18
|
| Rate for Payer: Cofinity Commercial |
$3,246.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,019.63
|
| Rate for Payer: Healthscope Commercial |
$3,397.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,642.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,830.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,208.36
|
| Rate for Payer: PHP Commercial |
$3,208.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,642.18
|
| Rate for Payer: Priority Health SBD |
$2,377.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,660.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.90
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$5.52
|
|
|
Service Code
|
NDC 0990-0000-65
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna American Axle |
$3.59
|
| Rate for Payer: Aetna Commercial |
$4.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.59
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$3.86
|
| Rate for Payer: Cofinity Commercial |
$4.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.42
|
| Rate for Payer: Healthscope Commercial |
$4.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.69
|
| Rate for Payer: PHP Commercial |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.86
|
| Rate for Payer: Priority Health SBD |
$3.48
|
| Rate for Payer: UMR Bronson Commercial |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.14
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$1,945.22
|
|
|
Service Code
|
NDC 42858-304-16
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$855.90 |
| Max. Negotiated Rate |
$1,750.70 |
| Rate for Payer: Aetna American Axle |
$1,264.39
|
| Rate for Payer: Aetna Commercial |
$1,653.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,264.39
|
| Rate for Payer: Cash Price |
$1,556.18
|
| Rate for Payer: Cofinity Commercial |
$1,361.65
|
| Rate for Payer: Cofinity Commercial |
$1,672.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,556.18
|
| Rate for Payer: Healthscope Commercial |
$1,750.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,361.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,458.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,653.44
|
| Rate for Payer: PHP Commercial |
$1,653.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,361.65
|
| Rate for Payer: Priority Health SBD |
$1,225.49
|
| Rate for Payer: UMR Bronson Commercial |
$855.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,458.92
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.39
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
3758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$21.95 |
| Rate for Payer: Aetna American Axle |
$15.85
|
| Rate for Payer: Aetna American Axle |
$64.02
|
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: Aetna Commercial |
$83.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.85
|
| Rate for Payer: Cash Price |
$78.80
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$68.95
|
| Rate for Payer: Cofinity Commercial |
$84.71
|
| Rate for Payer: Cofinity Commercial |
$17.07
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$88.65
|
| Rate for Payer: Healthscope Commercial |
$21.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.73
|
| Rate for Payer: PHP Commercial |
$20.73
|
| Rate for Payer: PHP Commercial |
$83.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health SBD |
$62.06
|
| Rate for Payer: Priority Health SBD |
$15.37
|
| Rate for Payer: UMR Bronson Commercial |
$10.73
|
| Rate for Payer: UMR Bronson Commercial |
$43.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.29
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$31.49
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna American Axle |
$20.47
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.04
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UMR Bronson Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$31.49
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Aetna American Axle |
$20.47
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.47
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$22.04
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.77
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.04
|
| Rate for Payer: Priority Health SBD |
$19.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
