|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Advantage |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health SBD |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
OP
|
$295.09
|
|
|
Service Code
|
NDC 00574042025
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.18 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna American Axle |
$191.81
|
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.81
|
| Rate for Payer: BCBS Complete |
$118.04
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$236.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.32
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: Priority Health SBD |
$185.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.81
|
| Rate for Payer: UHC Core |
$153.74
|
| Rate for Payer: UHC Exchange |
$115.97
|
| Rate for Payer: UMR Bronson Commercial |
$109.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.32
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
OP
|
$258.53
|
|
|
Service Code
|
NDC 38779000904
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.66 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Aetna American Axle |
$168.04
|
| Rate for Payer: Aetna Commercial |
$219.75
|
| Rate for Payer: Aetna Medicare |
$129.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.04
|
| Rate for Payer: BCBS Complete |
$103.41
|
| Rate for Payer: Cash Price |
$206.82
|
| Rate for Payer: Cofinity Advantage |
$180.97
|
| Rate for Payer: Cofinity Commercial |
$222.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.82
|
| Rate for Payer: Healthscope Commercial |
$232.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.90
|
| Rate for Payer: PHP Commercial |
$219.75
|
| Rate for Payer: Priority Health SBD |
$162.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.04
|
| Rate for Payer: UHC Core |
$134.69
|
| Rate for Payer: UHC Exchange |
$101.60
|
| Rate for Payer: UMR Bronson Commercial |
$95.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.90
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
NDC 00574042025
|
| 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 Advantage |
$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 Commercial |
$250.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.32
|
| Rate for Payer: PHP Commercial |
$250.83
|
| 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
|
$258.53
|
|
|
Service Code
|
NDC 38779000904
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.75 |
| Max. Negotiated Rate |
$232.68 |
| Rate for Payer: Aetna American Axle |
$168.04
|
| Rate for Payer: Aetna Commercial |
$219.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.04
|
| Rate for Payer: Cash Price |
$206.82
|
| Rate for Payer: Cofinity Advantage |
$180.97
|
| Rate for Payer: Cofinity Commercial |
$222.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.82
|
| Rate for Payer: Healthscope Commercial |
$232.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.90
|
| Rate for Payer: PHP Commercial |
$219.75
|
| Rate for Payer: Priority Health SBD |
$162.87
|
| Rate for Payer: UMR Bronson Commercial |
$113.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.90
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.88 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna American Axle |
$56.00
|
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: BCBS Complete |
$34.46
|
| Rate for Payer: BCBS Trust/PPO |
$71.51
|
| Rate for Payer: BCN Commercial |
$71.51
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Advantage |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health SBD |
$54.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Exchange |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$31.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$77.54 |
| Rate for Payer: Aetna American Axle |
$56.00
|
| Rate for Payer: Aetna Commercial |
$73.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.00
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Advantage |
$60.31
|
| Rate for Payer: Cofinity Commercial |
$74.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$77.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.62
|
| Rate for Payer: PHP Commercial |
$73.24
|
| Rate for Payer: Priority Health SBD |
$54.28
|
| Rate for Payer: UMR Bronson Commercial |
$37.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.62
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$107.59
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna American Axle |
$69.93
|
| Rate for Payer: Aetna American Axle |
$70.55
|
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Commercial |
$92.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.55
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cofinity Advantage |
$75.98
|
| Rate for Payer: Cofinity Advantage |
$75.31
|
| Rate for Payer: Cofinity Commercial |
$93.34
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.83
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Healthscope Commercial |
$97.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.41
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: PHP Commercial |
$92.26
|
| Rate for Payer: Priority Health SBD |
$68.38
|
| Rate for Payer: Priority Health SBD |
$67.78
|
| Rate for Payer: UMR Bronson Commercial |
$47.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.41
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$107.59
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna American Axle |
$69.93
|
| Rate for Payer: Aetna American Axle |
$70.55
|
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Commercial |
$92.26
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna Medicare |
$54.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.55
|
| Rate for Payer: BCBS Complete |
$43.42
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$71.51
|
| Rate for Payer: BCBS Trust/PPO |
$71.51
|
| Rate for Payer: BCN Commercial |
$71.51
|
| Rate for Payer: BCN Commercial |
$71.51
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cofinity Advantage |
$75.31
|
| Rate for Payer: Cofinity Advantage |
$75.98
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Cofinity Commercial |
$93.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.83
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Healthscope Commercial |
$97.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.69
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: PHP Commercial |
$92.26
|
| Rate for Payer: Priority Health SBD |
$67.78
|
| Rate for Payer: Priority Health SBD |
$68.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Exchange |
$36.40
|
| Rate for Payer: UHC Exchange |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$39.81
|
| Rate for Payer: UMR Bronson Commercial |
$40.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.41
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$208.51
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.74 |
| Max. Negotiated Rate |
$187.66 |
| Rate for Payer: Aetna American Axle |
$135.53
|
| Rate for Payer: Aetna American Axle |
$143.73
|
| Rate for Payer: Aetna Commercial |
$177.23
|
| Rate for Payer: Aetna Commercial |
$187.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.73
|
| Rate for Payer: Cash Price |
$166.81
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cofinity Advantage |
$154.79
|
| Rate for Payer: Cofinity Advantage |
$145.96
|
| Rate for Payer: Cofinity Commercial |
$190.17
|
| Rate for Payer: Cofinity Commercial |
$179.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Healthscope Commercial |
$187.66
|
| Rate for Payer: Healthscope Commercial |
$199.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.85
|
| Rate for Payer: PHP Commercial |
$177.23
|
| Rate for Payer: PHP Commercial |
$187.96
|
| Rate for Payer: Priority Health SBD |
$139.31
|
| Rate for Payer: Priority Health SBD |
$131.36
|
| Rate for Payer: UMR Bronson Commercial |
$91.74
|
| Rate for Payer: UMR Bronson Commercial |
$97.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.85
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$208.51
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$187.66 |
| Rate for Payer: Aetna American Axle |
$135.53
|
| Rate for Payer: Aetna American Axle |
$143.73
|
| Rate for Payer: Aetna Commercial |
$177.23
|
| Rate for Payer: Aetna Commercial |
$187.96
|
| Rate for Payer: Aetna Medicare |
$104.25
|
| Rate for Payer: Aetna Medicare |
$110.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.73
|
| Rate for Payer: BCBS Complete |
$88.45
|
| Rate for Payer: BCBS Complete |
$83.40
|
| Rate for Payer: BCBS Trust/PPO |
$71.51
|
| Rate for Payer: BCBS Trust/PPO |
$71.51
|
| Rate for Payer: BCN Commercial |
$71.51
|
| Rate for Payer: BCN Commercial |
$71.51
|
| Rate for Payer: Cash Price |
$166.81
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cash Price |
$166.81
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cofinity Advantage |
$145.96
|
| Rate for Payer: Cofinity Advantage |
$154.79
|
| Rate for Payer: Cofinity Commercial |
$179.32
|
| Rate for Payer: Cofinity Commercial |
$190.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Healthscope Commercial |
$187.66
|
| Rate for Payer: Healthscope Commercial |
$199.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.38
|
| Rate for Payer: PHP Commercial |
$177.23
|
| Rate for Payer: PHP Commercial |
$187.96
|
| Rate for Payer: Priority Health SBD |
$131.36
|
| Rate for Payer: Priority Health SBD |
$139.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.40
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Core |
$36.40
|
| Rate for Payer: UHC Exchange |
$36.40
|
| Rate for Payer: UHC Exchange |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$77.15
|
| Rate for Payer: UMR Bronson Commercial |
$81.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.85
|
|
|
HYDROMORPHONE 0.2 MG/ML PEDIATRIC PCA IV SOLUTION 50 ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301645
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$80.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 0.2 MG/ML PEDIATRIC PCA IV SOLUTION 50 ML
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| 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 Advantage |
$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 Commercial |
$85.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| 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
|
OP
|
$21.41
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna American Axle |
$13.92
|
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$13.12
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Aetna Commercial |
$17.16
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.12
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Advantage |
$14.99
|
| Rate for Payer: Cofinity Advantage |
$14.13
|
| Rate for Payer: Cofinity Advantage |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$18.17
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.06
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$17.16
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: Priority Health SBD |
$12.72
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: UMR Bronson Commercial |
$6.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.14
|
| 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 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$20.19
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$18.17 |
| Rate for Payer: Aetna American Axle |
$13.12
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$13.92
|
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Aetna Commercial |
$17.16
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| 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: Cash Price |
$16.15
|
| Rate for Payer: Cofinity Advantage |
$11.54
|
| Rate for Payer: Cofinity Advantage |
$9.85
|
| Rate for Payer: Cofinity Advantage |
$14.13
|
| Rate for Payer: Cofinity Advantage |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$18.17
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| 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: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.14
|
| 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 Commercial |
$18.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$17.16
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: Priority Health SBD |
$12.72
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
| 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
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| 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 |
$85.00
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Advantage |
$70.00
|
| Rate for Payer: Cofinity Advantage |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: UMR Bronson Commercial |
$28.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) ADULT AVERAGE PCA IV SOLUTION 50 ML
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301640
|
|
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 |
$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 |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Advantage |
$54.60
|
| Rate for Payer: Cofinity Advantage |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| 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 Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.50
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| 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 |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) ADULT TOLERANT PCA IV SOLUTION 50 ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301641
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| 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 |
$85.00
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$39.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Advantage |
$70.00
|
| Rate for Payer: Cofinity Advantage |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: UMR Bronson Commercial |
$28.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) ADULT TOLERANT PCA IV SOLUTION 50 ML
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301641
|
|
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 |
$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 |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Advantage |
$54.60
|
| Rate for Payer: Cofinity Advantage |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.40
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| 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 Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.50
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| 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 |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$31.97
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Medicare |
$14.03
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna Medicare |
$15.98
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.24
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Advantage |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.64
|
| Rate for Payer: Cofinity Advantage |
$15.31
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| 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 |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$11.73
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$18.62
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna American Axle |
$12.10
|
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.24
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cofinity Advantage |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Advantage |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$16.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: Priority Health SBD |
$11.73
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: UMR Bronson Commercial |
$8.19
|
| Rate for Payer: UMR Bronson Commercial |
$14.07
|
| Rate for Payer: UMR Bronson Commercial |
$12.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$2,458.42
|
|
|
Service Code
|
NDC 42858030416
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,081.70 |
| Max. Negotiated Rate |
$2,212.58 |
| Rate for Payer: Aetna American Axle |
$1,597.97
|
| Rate for Payer: Aetna Commercial |
$2,089.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.97
|
| Rate for Payer: Cash Price |
$1,966.74
|
| Rate for Payer: Cofinity Advantage |
$1,720.89
|
| Rate for Payer: Cofinity Commercial |
$2,114.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.74
|
| Rate for Payer: Healthscope Commercial |
$2,212.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,720.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,843.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,843.82
|
| Rate for Payer: PHP Commercial |
$2,089.66
|
| Rate for Payer: Priority Health SBD |
$1,548.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,843.82
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$5.52
|
|
|
Service Code
|
NDC 09900000065
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna American Axle |
$3.59
|
| Rate for Payer: Aetna Commercial |
$4.69
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.59
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.14
|
| Rate for Payer: PHP Commercial |
$4.69
|
| Rate for Payer: Priority Health SBD |
$3.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.59
|
| Rate for Payer: UHC Core |
$2.88
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UMR Bronson Commercial |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.14
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$5.52
|
|
|
Service Code
|
NDC 09900000065
|
| 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 Advantage |
$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 Commercial |
$4.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.14
|
| Rate for Payer: PHP Commercial |
$4.69
|
| 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
|
OP
|
$2,458.42
|
|
|
Service Code
|
NDC 42858030416
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$909.62 |
| Max. Negotiated Rate |
$2,212.58 |
| Rate for Payer: Aetna American Axle |
$1,597.97
|
| Rate for Payer: Aetna Commercial |
$2,089.66
|
| Rate for Payer: Aetna Medicare |
$1,229.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.97
|
| Rate for Payer: BCBS Complete |
$983.37
|
| Rate for Payer: Cash Price |
$1,966.74
|
| Rate for Payer: Cofinity Advantage |
$1,720.89
|
| Rate for Payer: Cofinity Commercial |
$2,114.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,966.74
|
| Rate for Payer: Healthscope Commercial |
$2,212.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,720.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,843.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,966.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,089.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,843.82
|
| Rate for Payer: PHP Commercial |
$2,089.66
|
| Rate for Payer: Priority Health SBD |
$1,548.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,597.97
|
| Rate for Payer: UHC Core |
$1,280.84
|
| Rate for Payer: UHC Exchange |
$966.16
|
| Rate for Payer: UMR Bronson Commercial |
$909.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,843.82
|
|
