|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 42858-301-01
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$269.50
|
|
|
Service Code
|
NDC 42858-301-25
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna American Axle |
$175.18
|
| Rate for Payer: Aetna Commercial |
$229.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.18
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$188.65
|
| Rate for Payer: Cofinity Commercial |
$231.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.60
|
| Rate for Payer: Healthscope Commercial |
$242.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.08
|
| Rate for Payer: PHP Commercial |
$229.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health SBD |
$169.78
|
| Rate for Payer: UMR Bronson Commercial |
$118.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.12
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$337.75
|
|
|
Service Code
|
NDC 60687-579-01
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.61 |
| Max. Negotiated Rate |
$303.98 |
| Rate for Payer: Aetna American Axle |
$219.54
|
| Rate for Payer: Aetna Commercial |
$287.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.54
|
| Rate for Payer: Cash Price |
$270.20
|
| Rate for Payer: Cofinity Commercial |
$236.42
|
| Rate for Payer: Cofinity Commercial |
$290.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.20
|
| Rate for Payer: Healthscope Commercial |
$303.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.09
|
| Rate for Payer: PHP Commercial |
$287.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.42
|
| Rate for Payer: Priority Health SBD |
$212.78
|
| Rate for Payer: UMR Bronson Commercial |
$148.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.31
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 60687-579-11
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.87
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$248.50
|
|
|
Service Code
|
NDC 0406-3243-01
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$223.65 |
| Rate for Payer: Aetna American Axle |
$161.52
|
| Rate for Payer: Aetna Commercial |
$211.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.52
|
| Rate for Payer: Cash Price |
$198.80
|
| Rate for Payer: Cofinity Commercial |
$173.95
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.80
|
| Rate for Payer: Healthscope Commercial |
$223.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.22
|
| Rate for Payer: PHP Commercial |
$211.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.95
|
| Rate for Payer: Priority Health SBD |
$156.56
|
| Rate for Payer: UMR Bronson Commercial |
$109.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.38
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 42858-302-25
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$239.70
|
|
|
Service Code
|
NDC 42858-302-01
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.47 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna American Axle |
$155.80
|
| Rate for Payer: Aetna Commercial |
$203.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.80
|
| Rate for Payer: Cash Price |
$191.76
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$206.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.76
|
| Rate for Payer: Healthscope Commercial |
$215.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.74
|
| Rate for Payer: PHP Commercial |
$203.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.79
|
| Rate for Payer: Priority Health SBD |
$151.01
|
| Rate for Payer: UMR Bronson Commercial |
$105.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.78
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$2.33
|
|
|
Service Code
|
NDC 60687-590-11
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna American Axle |
$1.51
|
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.51
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$1.63
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.98
|
| Rate for Payer: PHP Commercial |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.63
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.75
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 60687-590-01
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.48 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$162.92
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.84
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.92
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
HYDROMORPHONE (PF) 0.2 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
119571
|
|
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 American Axle |
$50.70
|
| 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 |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| 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 |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| 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 (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$315.53
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$283.98 |
| Rate for Payer: Aetna American Axle |
$205.09
|
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna American Axle |
$13.94
|
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Commercial |
$18.23
|
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.09
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cash Price |
$252.42
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$220.87
|
| Rate for Payer: Cofinity Commercial |
$271.36
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$283.98
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.20
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$268.20
|
| Rate for Payer: PHP Commercial |
$18.23
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.24
|
| Rate for Payer: Priority Health SBD |
$13.51
|
| Rate for Payer: Priority Health SBD |
$198.78
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: UMR Bronson Commercial |
$9.44
|
| Rate for Payer: UMR Bronson Commercial |
$138.83
|
| Rate for Payer: UMR Bronson Commercial |
$34.09
|
| Rate for Payer: UMR Bronson Commercial |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$26.64
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
117123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$23.98 |
| Rate for Payer: Aetna American Axle |
$17.32
|
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$22.64
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cash Price |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$18.65
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Cofinity Commercial |
$22.91
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Healthscope Commercial |
$23.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.64
|
| Rate for Payer: PHP Commercial |
$22.64
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.65
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: Priority Health SBD |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: UMR Bronson Commercial |
$11.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| 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: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$14.81 |
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$14.81
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| 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: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,650.82
|
|
|
Service Code
|
NDC 11704-370-01
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,166.36 |
| Max. Negotiated Rate |
$2,385.74 |
| Rate for Payer: Aetna American Axle |
$1,723.03
|
| Rate for Payer: Aetna Commercial |
$2,253.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,723.03
|
| Rate for Payer: Cash Price |
$2,120.66
|
| Rate for Payer: Cofinity Commercial |
$1,855.57
|
| Rate for Payer: Cofinity Commercial |
$2,279.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.66
|
| Rate for Payer: Healthscope Commercial |
$2,385.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,855.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,988.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,253.20
|
| Rate for Payer: PHP Commercial |
$2,253.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.57
|
| Rate for Payer: Priority Health SBD |
$1,670.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,166.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,988.12
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,883.75
|
|
|
Service Code
|
NDC 50633-310-11
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,268.85 |
| Max. Negotiated Rate |
$2,595.38 |
| Rate for Payer: Aetna American Axle |
$1,874.44
|
| Rate for Payer: Aetna Commercial |
$2,451.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.44
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cofinity Commercial |
$2,480.02
|
| Rate for Payer: Cofinity Commercial |
$2,018.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,307.00
|
| Rate for Payer: Healthscope Commercial |
$2,595.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,018.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,162.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,451.19
|
| Rate for Payer: PHP Commercial |
$2,451.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,018.62
|
| Rate for Payer: Priority Health SBD |
$1,816.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,268.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,162.81
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$593.76
|
|
|
Service Code
|
NDC 68084-269-11
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.25 |
| Max. Negotiated Rate |
$534.38 |
| Rate for Payer: Aetna American Axle |
$385.94
|
| Rate for Payer: Aetna Commercial |
$504.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.94
|
| Rate for Payer: Cash Price |
$475.01
|
| Rate for Payer: Cofinity Commercial |
$415.63
|
| Rate for Payer: Cofinity Commercial |
$510.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.01
|
| Rate for Payer: Healthscope Commercial |
$534.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$415.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$504.70
|
| Rate for Payer: PHP Commercial |
$504.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.63
|
| Rate for Payer: Priority Health SBD |
$374.07
|
| Rate for Payer: UMR Bronson Commercial |
$261.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.32
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$306.72
|
|
|
Service Code
|
NDC 68382-096-01
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna American Axle |
$199.37
|
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: UMR Bronson Commercial |
$134.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.04
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$1,456.80
|
|
|
Service Code
|
NDC 68382-096-05
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$640.99 |
| Max. Negotiated Rate |
$1,311.12 |
| Rate for Payer: Aetna American Axle |
$946.92
|
| Rate for Payer: Aetna Commercial |
$1,238.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.92
|
| Rate for Payer: Cash Price |
$1,165.44
|
| Rate for Payer: Cofinity Commercial |
$1,019.76
|
| Rate for Payer: Cofinity Commercial |
$1,252.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.44
|
| Rate for Payer: Healthscope Commercial |
$1,311.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,238.28
|
| Rate for Payer: PHP Commercial |
$1,238.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,019.76
|
| Rate for Payer: Priority Health SBD |
$917.78
|
| Rate for Payer: UMR Bronson Commercial |
$640.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.60
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$379.68
|
|
|
Service Code
|
NDC 0781-5994-01
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.78
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$167.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
NDC 63304-296-01
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.71 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.36
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$193.20
|
|
|
Service Code
|
NDC 0904-7046-06
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.01 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna American Axle |
$125.58
|
| Rate for Payer: Aetna Commercial |
$164.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.58
|
| Rate for Payer: Cash Price |
$154.56
|
| Rate for Payer: Cofinity Commercial |
$135.24
|
| Rate for Payer: Cofinity Commercial |
$166.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.56
|
| Rate for Payer: Healthscope Commercial |
$173.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.22
|
| Rate for Payer: PHP Commercial |
$164.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.24
|
| Rate for Payer: Priority Health SBD |
$121.72
|
| Rate for Payer: UMR Bronson Commercial |
$85.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.90
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 43598-721-01
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.14
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 49884-724-01
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.06
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UMR Bronson Commercial |
$110.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$244.15
|
|
|
Service Code
|
NDC 69315-164-01
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.43 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna American Axle |
$158.70
|
| Rate for Payer: Aetna Commercial |
$207.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.70
|
| Rate for Payer: Cash Price |
$195.32
|
| Rate for Payer: Cofinity Commercial |
$170.90
|
| Rate for Payer: Cofinity Commercial |
$209.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.32
|
| Rate for Payer: Healthscope Commercial |
$219.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.53
|
| Rate for Payer: PHP Commercial |
$207.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.90
|
| Rate for Payer: Priority Health SBD |
$153.81
|
| Rate for Payer: UMR Bronson Commercial |
$107.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.11
|
|
