|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna American Axle |
$63.43
|
| Rate for Payer: Aetna American Axle |
$63.93
|
| Rate for Payer: Aetna Commercial |
$82.94
|
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Medicare |
$48.79
|
| Rate for Payer: Aetna Medicare |
$49.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.93
|
| Rate for Payer: BCBS Complete |
$39.34
|
| Rate for Payer: BCBS Complete |
$39.03
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.68
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Cofinity Commercial |
$68.84
|
| Rate for Payer: Cofinity Commercial |
$84.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.68
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.60
|
| Rate for Payer: PHP Commercial |
$83.60
|
| Rate for Payer: PHP Commercial |
$82.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.93
|
| Rate for Payer: Priority Health SBD |
$61.96
|
| Rate for Payer: Priority Health SBD |
$61.48
|
| Rate for Payer: UMR Bronson Commercial |
$36.10
|
| Rate for Payer: UMR Bronson Commercial |
$36.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.19
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$87.82 |
| Rate for Payer: Aetna American Axle |
$63.43
|
| Rate for Payer: Aetna American Axle |
$63.93
|
| Rate for Payer: Aetna Commercial |
$82.94
|
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.93
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.68
|
| Rate for Payer: Cofinity Commercial |
$84.58
|
| Rate for Payer: Cofinity Commercial |
$68.84
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.68
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: PHP Commercial |
$83.60
|
| Rate for Payer: PHP Commercial |
$82.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.93
|
| Rate for Payer: Priority Health SBD |
$61.48
|
| Rate for Payer: Priority Health SBD |
$61.96
|
| Rate for Payer: UMR Bronson Commercial |
$42.94
|
| Rate for Payer: UMR Bronson Commercial |
$43.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.76
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$180.53
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$162.48 |
| Rate for Payer: Aetna American Axle |
$117.34
|
| Rate for Payer: Aetna American Axle |
$118.91
|
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: Aetna Commercial |
$155.50
|
| Rate for Payer: Aetna Medicare |
$90.27
|
| Rate for Payer: Aetna Medicare |
$91.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.91
|
| Rate for Payer: BCBS Complete |
$73.18
|
| Rate for Payer: BCBS Complete |
$72.21
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$128.06
|
| Rate for Payer: Cofinity Commercial |
$157.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.35
|
| Rate for Payer: Healthscope Commercial |
$164.65
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.50
|
| Rate for Payer: PHP Commercial |
$155.50
|
| Rate for Payer: PHP Commercial |
$153.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.91
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: Priority Health SBD |
$113.73
|
| Rate for Payer: UMR Bronson Commercial |
$66.80
|
| Rate for Payer: UMR Bronson Commercial |
$67.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.40
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$180.53
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$162.48 |
| Rate for Payer: Aetna American Axle |
$117.34
|
| Rate for Payer: Aetna American Axle |
$118.91
|
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: Aetna Commercial |
$155.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.91
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$157.33
|
| Rate for Payer: Cofinity Commercial |
$128.06
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$155.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.35
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Healthscope Commercial |
$164.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.45
|
| Rate for Payer: PHP Commercial |
$155.50
|
| Rate for Payer: PHP Commercial |
$153.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.91
|
| Rate for Payer: Priority Health SBD |
$113.73
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: UMR Bronson Commercial |
$79.43
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.21
|
|
|
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 Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| 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: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| 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 0.2 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 |
$37.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| 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: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$10.01
|
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna American Axle |
$13.92
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$10.78
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| 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: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.55
|
| 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: 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 |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$7.25
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.78
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$15.40
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna American Axle |
$10.01
|
| 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 Commercial |
$18.20
|
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: Aetna Medicare |
$10.71
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS Complete |
$8.56
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$10.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.99
|
| 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: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| 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 |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health SBD |
$10.38
|
| Rate for Payer: Priority Health SBD |
$13.49
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$6.10
|
| Rate for Payer: UMR Bronson Commercial |
$5.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.55
|
|
|
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 |
$37.00 |
| 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 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: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| 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 |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| 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 |
$58.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
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 Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.60
|
| 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: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$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 Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.60
|
| 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: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: UMR Bronson Commercial |
$44.00
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$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 |
$37.00 |
| 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 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: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Commercial |
$54.60
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| 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 |
$70.20
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| 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: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| 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 |
$58.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$17.06
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna American Axle |
$11.09
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.24
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.94
|
| 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 |
$12.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: UMR Bronson Commercial |
$7.51
|
| 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 |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$21.87
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna American Axle |
$11.09
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Medicare |
$14.03
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna Medicare |
$15.98
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
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 Commercial |
$1,720.89
|
| Rate for Payer: Cofinity Commercial |
$2,114.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,720.89
|
| 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: PHP Commercial |
$2,089.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.97
|
| 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
|
$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 Commercial |
$2,642.18
|
| Rate for Payer: Cofinity Commercial |
$3,246.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,642.18
|
| 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: PHP Commercial |
$3,208.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,453.45
|
| Rate for Payer: Priority Health SBD |
$2,377.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,396.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,830.91
|
|
|
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 Commercial |
$3.86
|
| Rate for Payer: Cofinity Commercial |
$4.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.86
|
| 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: PHP Commercial |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.59
|
| 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 Commercial |
$1,720.89
|
| Rate for Payer: Cofinity Commercial |
$2,114.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,720.89
|
| 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: PHP Commercial |
$2,089.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,597.97
|
| Rate for Payer: Priority Health SBD |
$1,548.80
|
| Rate for Payer: UMR Bronson Commercial |
$909.62
|
| 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 Commercial |
$3.86
|
| Rate for Payer: Cofinity Commercial |
$4.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.86
|
| 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: PHP Commercial |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.59
|
| Rate for Payer: Priority Health SBD |
$3.48
|
| 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
|
$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 Commercial |
$2,642.18
|
| Rate for Payer: Cofinity Commercial |
$3,246.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,642.18
|
| 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: PHP Commercial |
$3,208.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,453.45
|
| 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 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$98.50
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
3758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.34 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Aetna American Axle |
$64.03
|
| Rate for Payer: Aetna Commercial |
$83.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.03
|
| Rate for Payer: Cash Price |
$78.80
|
| Rate for Payer: Cofinity Commercial |
$68.95
|
| Rate for Payer: Cofinity Commercial |
$84.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.80
|
| Rate for Payer: Healthscope Commercial |
$88.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.72
|
| Rate for Payer: PHP Commercial |
$83.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.03
|
| Rate for Payer: Priority Health SBD |
$62.05
|
| Rate for Payer: UMR Bronson Commercial |
$43.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.88
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$98.50
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
3758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.45 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Aetna American Axle |
$64.03
|
| Rate for Payer: Aetna Commercial |
$83.72
|
| Rate for Payer: Aetna Medicare |
$49.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.03
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: Cash Price |
$78.80
|
| Rate for Payer: Cofinity Commercial |
$68.95
|
| Rate for Payer: Cofinity Commercial |
$84.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.80
|
| Rate for Payer: Healthscope Commercial |
$88.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.72
|
| Rate for Payer: PHP Commercial |
$83.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.03
|
| Rate for Payer: Priority Health SBD |
$62.05
|
| Rate for Payer: UMR Bronson Commercial |
$36.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.88
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$34.01
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$30.61 |
| Rate for Payer: Aetna American Axle |
$22.11
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.11
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.21
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: PHP Commercial |
$28.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.11
|
| Rate for Payer: Priority Health SBD |
$21.43
|
| Rate for Payer: UMR Bronson Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.51
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$34.01
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$30.61 |
| Rate for Payer: Aetna American Axle |
$22.11
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.11
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$29.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.21
|
| Rate for Payer: Healthscope Commercial |
$30.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.91
|
| Rate for Payer: PHP Commercial |
$28.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.11
|
| Rate for Payer: Priority Health SBD |
$21.43
|
| Rate for Payer: UMR Bronson Commercial |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.51
|
|
|
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 Commercial |
$270.73
|
| Rate for Payer: Cofinity Commercial |
$332.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.73
|
| 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: PHP Commercial |
$328.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.39
|
| 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
|
|
