|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
IP
|
$3,774.54
|
|
|
Service Code
|
NDC 00054038663
|
| 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 Advantage |
$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 |
$2,830.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,208.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,830.91
|
| Rate for Payer: PHP Commercial |
$3,208.36
|
| 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 |
$2,830.91
|
|
|
HYDROMORPHONE 1 MG/ML ORAL LIQUID
|
Facility
|
OP
|
$3,774.54
|
|
|
Service Code
|
NDC 00054038663
|
| Hospital Charge Code |
10225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,396.58 |
| 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 Medicare |
$1,887.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,453.45
|
| Rate for Payer: BCBS Complete |
$1,509.82
|
| Rate for Payer: Cash Price |
$3,019.63
|
| Rate for Payer: Cofinity Advantage |
$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 |
$2,830.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,019.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,208.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,830.91
|
| Rate for Payer: PHP Commercial |
$3,208.36
|
| Rate for Payer: Priority Health SBD |
$2,377.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,453.45
|
| Rate for Payer: UHC Core |
$1,966.54
|
| Rate for Payer: UHC Exchange |
$1,483.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,396.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.91
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
NDC 00406324301
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna American Axle |
$200.20
|
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Advantage |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health SBD |
$194.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.20
|
| Rate for Payer: UHC Core |
$160.47
|
| Rate for Payer: UHC Exchange |
$121.04
|
| Rate for Payer: UMR Bronson Commercial |
$113.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.00
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 60687057911
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna American Axle |
$3.91
|
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: Aetna Medicare |
$3.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.91
|
| Rate for Payer: BCBS Complete |
$2.41
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Advantage |
$4.21
|
| Rate for Payer: Cofinity Commercial |
$5.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.51
|
| Rate for Payer: PHP Commercial |
$5.12
|
| Rate for Payer: Priority Health SBD |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.91
|
| Rate for Payer: UHC Core |
$3.14
|
| Rate for Payer: UHC Exchange |
$2.37
|
| Rate for Payer: UMR Bronson Commercial |
$2.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.51
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
NDC 60687057901
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.74 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna American Axle |
$391.30
|
| Rate for Payer: Aetna Commercial |
$511.70
|
| Rate for Payer: Aetna Medicare |
$301.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.30
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Advantage |
$421.40
|
| Rate for Payer: Cofinity Commercial |
$517.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.60
|
| Rate for Payer: Healthscope Commercial |
$541.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$481.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.50
|
| Rate for Payer: PHP Commercial |
$511.70
|
| Rate for Payer: Priority Health SBD |
$379.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.30
|
| Rate for Payer: UHC Core |
$313.64
|
| Rate for Payer: UHC Exchange |
$236.59
|
| Rate for Payer: UMR Bronson Commercial |
$222.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.50
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
NDC 60687057901
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$541.80 |
| Rate for Payer: Aetna American Axle |
$391.30
|
| Rate for Payer: Aetna Commercial |
$511.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.30
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Advantage |
$421.40
|
| Rate for Payer: Cofinity Commercial |
$517.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$481.60
|
| Rate for Payer: Healthscope Commercial |
$541.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$421.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$451.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$511.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.50
|
| Rate for Payer: PHP Commercial |
$511.70
|
| Rate for Payer: Priority Health SBD |
$379.26
|
| Rate for Payer: UMR Bronson Commercial |
$264.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$451.50
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna American Axle |
$176.31
|
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna Medicare |
$135.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.31
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Advantage |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.44
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health SBD |
$170.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.31
|
| Rate for Payer: UHC Core |
$141.32
|
| Rate for Payer: UHC Exchange |
$106.60
|
| Rate for Payer: UMR Bronson Commercial |
$100.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$386.75
|
|
|
Service Code
|
NDC 42858030101
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$348.07 |
| Rate for Payer: Aetna American Axle |
$251.39
|
| Rate for Payer: Aetna Commercial |
$328.74
|
| Rate for Payer: Aetna Medicare |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.39
|
| Rate for Payer: BCBS Complete |
$154.70
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cofinity Advantage |
$270.73
|
| Rate for Payer: Cofinity Commercial |
$332.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.40
|
| Rate for Payer: Healthscope Commercial |
$348.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.06
|
| Rate for Payer: PHP Commercial |
$328.74
|
| Rate for Payer: Priority Health SBD |
$243.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.39
|
| Rate for Payer: UHC Core |
$201.50
|
| Rate for Payer: UHC Exchange |
$151.99
|
| Rate for Payer: UMR Bronson Commercial |
$143.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.06
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$386.75
|
|
|
Service Code
|
NDC 42858030101
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.17 |
| Max. Negotiated Rate |
$348.07 |
| Rate for Payer: Aetna American Axle |
$251.39
|
| Rate for Payer: Aetna Commercial |
$328.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.39
|
| Rate for Payer: Cash Price |
$309.40
|
| Rate for Payer: Cofinity Advantage |
$270.73
|
| Rate for Payer: Cofinity Commercial |
$332.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.40
|
| Rate for Payer: Healthscope Commercial |
$348.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.06
|
| Rate for Payer: PHP Commercial |
$328.74
|
| Rate for Payer: Priority Health SBD |
$243.65
|
| Rate for Payer: UMR Bronson Commercial |
$170.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.06
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$271.25
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.35 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna American Axle |
$176.31
|
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.31
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Advantage |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.44
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health SBD |
$170.89
|
| Rate for Payer: UMR Bronson Commercial |
$119.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$6.02
|
|
|
Service Code
|
NDC 60687057911
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna American Axle |
$3.91
|
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.91
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Advantage |
$4.21
|
| Rate for Payer: Cofinity Commercial |
$5.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.51
|
| Rate for Payer: PHP Commercial |
$5.12
|
| Rate for Payer: Priority Health SBD |
$3.79
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.51
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
NDC 00406324301
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna American Axle |
$200.20
|
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Advantage |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health SBD |
$194.04
|
| Rate for Payer: UMR Bronson Commercial |
$135.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.00
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$303.05
|
|
|
Service Code
|
NDC 42858030201
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.13 |
| Max. Negotiated Rate |
$272.75 |
| Rate for Payer: Aetna American Axle |
$196.98
|
| Rate for Payer: Aetna Commercial |
$257.59
|
| Rate for Payer: Aetna Medicare |
$151.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cofinity Advantage |
$212.13
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.44
|
| Rate for Payer: Healthscope Commercial |
$272.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.29
|
| Rate for Payer: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.98
|
| Rate for Payer: UHC Core |
$157.89
|
| Rate for Payer: UHC Exchange |
$119.10
|
| Rate for Payer: UMR Bronson Commercial |
$112.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$429.40
|
|
|
Service Code
|
NDC 60687059001
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.94 |
| Max. Negotiated Rate |
$386.46 |
| Rate for Payer: Aetna American Axle |
$279.11
|
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.11
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cofinity Advantage |
$300.58
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.05
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: Priority Health SBD |
$270.52
|
| Rate for Payer: UMR Bronson Commercial |
$188.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.05
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.71 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna Medicare |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: BCBS Complete |
$77.52
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$155.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.97
|
| Rate for Payer: UHC Core |
$100.97
|
| Rate for Payer: UHC Exchange |
$76.16
|
| Rate for Payer: UMR Bronson Commercial |
$71.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 60687059011
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.79
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Exchange |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$303.05
|
|
|
Service Code
|
NDC 42858030201
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.34 |
| Max. Negotiated Rate |
$272.75 |
| Rate for Payer: Aetna American Axle |
$196.98
|
| Rate for Payer: Aetna Commercial |
$257.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.98
|
| Rate for Payer: Cash Price |
$242.44
|
| Rate for Payer: Cofinity Advantage |
$212.13
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.44
|
| Rate for Payer: Healthscope Commercial |
$272.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.29
|
| Rate for Payer: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UMR Bronson Commercial |
$133.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$429.40
|
|
|
Service Code
|
NDC 60687059001
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$386.46 |
| Rate for Payer: Aetna American Axle |
$279.11
|
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: Aetna Medicare |
$214.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.11
|
| Rate for Payer: BCBS Complete |
$171.76
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cofinity Advantage |
$300.58
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$343.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.05
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: Priority Health SBD |
$270.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.11
|
| Rate for Payer: UHC Core |
$223.72
|
| Rate for Payer: UHC Exchange |
$168.75
|
| Rate for Payer: UMR Bronson Commercial |
$158.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.05
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 60687059011
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna American Axle |
$2.79
|
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.79
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Advantage |
$3.01
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health SBD |
$2.71
|
| Rate for Payer: UMR Bronson Commercial |
$1.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$193.80
|
|
|
Service Code
|
NDC 42858030225
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$174.42 |
| Rate for Payer: Aetna American Axle |
$125.97
|
| Rate for Payer: Aetna Commercial |
$164.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.97
|
| Rate for Payer: Cash Price |
$155.04
|
| Rate for Payer: Cofinity Advantage |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.04
|
| Rate for Payer: Healthscope Commercial |
$174.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.35
|
| Rate for Payer: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$85.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
HYDROMORPHONE (PF) 0.2 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
119571
|
|
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 (PF) 0.2 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| 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 |
$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 (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$40.50
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$14.07
|
| Rate for Payer: Aetna American Axle |
$210.10
|
| Rate for Payer: Aetna American Axle |
$24.73
|
| Rate for Payer: Aetna American Axle |
$19.85
|
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna American Axle |
$44.93
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$274.75
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$25.96
|
| Rate for Payer: Aetna Commercial |
$58.76
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Aetna Medicare |
$38.74
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna Medicare |
$34.56
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Aetna Medicare |
$15.27
|
| Rate for Payer: Aetna Medicare |
$161.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.93
|
| Rate for Payer: BCBS Complete |
$12.22
|
| Rate for Payer: BCBS Complete |
$30.99
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS Complete |
$27.65
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: BCBS Complete |
$129.29
|
| 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: 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: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cofinity Advantage |
$26.64
|
| Rate for Payer: Cofinity Advantage |
$226.26
|
| Rate for Payer: Cofinity Advantage |
$21.38
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Advantage |
$48.39
|
| Rate for Payer: Cofinity Advantage |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$290.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.24
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$18.40
|
| Rate for Payer: PHP Commercial |
$25.96
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$58.76
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health SBD |
$43.55
|
| Rate for Payer: Priority Health SBD |
$203.63
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health SBD |
$19.24
|
| Rate for Payer: Priority Health SBD |
$13.64
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| 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 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 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: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.30
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$28.67
|
| Rate for Payer: UMR Bronson Commercial |
$25.58
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.54
|
|
|
HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.65
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna American Axle |
$14.07
|
| Rate for Payer: Aetna American Axle |
$210.10
|
| Rate for Payer: Aetna American Axle |
$24.73
|
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna American Axle |
$44.93
|
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$19.85
|
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$25.96
|
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: Aetna Commercial |
$274.75
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$58.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$48.39
|
| Rate for Payer: Cofinity Advantage |
$15.15
|
| Rate for Payer: Cofinity Advantage |
$21.38
|
| Rate for Payer: Cofinity Advantage |
$26.64
|
| Rate for Payer: Cofinity Advantage |
$226.26
|
| Rate for Payer: Cofinity Advantage |
$28.35
|
| Rate for Payer: Cofinity Advantage |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.43
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$290.91
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.91
|
| Rate for Payer: PHP Commercial |
$25.96
|
| Rate for Payer: PHP Commercial |
$58.76
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: PHP Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$18.40
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health SBD |
$13.64
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$43.55
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health SBD |
$19.24
|
| Rate for Payer: Priority Health SBD |
$203.63
|
| Rate for Payer: UMR Bronson Commercial |
$34.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: UMR Bronson Commercial |
$16.74
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: UMR Bronson Commercial |
$30.42
|
| Rate for Payer: UMR Bronson Commercial |
$142.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| 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 Advantage |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: 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 Commercial |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: PHP Commercial |
$11.96
|
| 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
|
|
