|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 60687057911
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health SBD |
$3.66
|
| Rate for Payer: UMR Bronson Commercial |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
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 Commercial |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.88
|
| 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: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health SBD |
$170.89
|
| Rate for Payer: UMR Bronson Commercial |
$100.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
NDC 60687057901
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna American Axle |
$377.65
|
| Rate for Payer: Aetna Commercial |
$493.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.65
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$406.70
|
| Rate for Payer: Cofinity Commercial |
$499.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$406.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.80
|
| Rate for Payer: Healthscope Commercial |
$522.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.85
|
| Rate for Payer: PHP Commercial |
$493.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.65
|
| Rate for Payer: Priority Health SBD |
$366.03
|
| Rate for Payer: UMR Bronson Commercial |
$255.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.75
|
|
|
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 Commercial |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.60
|
| 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: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| 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 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 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 |
$143.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.06
|
|
|
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 Commercial |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.60
|
| 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: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health SBD |
$194.04
|
| 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
|
$5.81
|
|
|
Service Code
|
NDC 60687057911
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health SBD |
$3.66
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
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 Commercial |
$189.88
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.88
|
| 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: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| 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
|
OP
|
$581.00
|
|
|
Service Code
|
NDC 60687057901
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.97 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna American Axle |
$377.65
|
| Rate for Payer: Aetna Commercial |
$493.85
|
| Rate for Payer: Aetna Medicare |
$290.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.65
|
| Rate for Payer: BCBS Complete |
$232.40
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$406.70
|
| Rate for Payer: Cofinity Commercial |
$499.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$406.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.80
|
| Rate for Payer: Healthscope Commercial |
$522.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$493.85
|
| Rate for Payer: PHP Commercial |
$493.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.65
|
| Rate for Payer: Priority Health SBD |
$366.03
|
| Rate for Payer: UMR Bronson Commercial |
$214.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.75
|
|
|
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 Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| 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: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| 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 4 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 60687059011
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
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 Commercial |
$212.13
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.13
|
| 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: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.98
|
| 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
|
$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 Commercial |
$212.13
|
| Rate for Payer: Cofinity Commercial |
$260.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.13
|
| 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: PHP Commercial |
$257.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.98
|
| Rate for Payer: Priority Health SBD |
$190.92
|
| Rate for Payer: UMR Bronson Commercial |
$112.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.29
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$368.60
|
|
|
Service Code
|
NDC 60687059001
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.38 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna American Axle |
$239.59
|
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna Medicare |
$184.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.59
|
| Rate for Payer: BCBS Complete |
$147.44
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.59
|
| Rate for Payer: Priority Health SBD |
$232.22
|
| Rate for Payer: UMR Bronson Commercial |
$136.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
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 Commercial |
$135.66
|
| Rate for Payer: Cofinity Commercial |
$166.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.66
|
| 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: PHP Commercial |
$164.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.97
|
| Rate for Payer: Priority Health SBD |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$71.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.35
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$368.60
|
|
|
Service Code
|
NDC 60687059001
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.18 |
| Max. Negotiated Rate |
$331.74 |
| Rate for Payer: Aetna American Axle |
$239.59
|
| Rate for Payer: Aetna Commercial |
$313.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.59
|
| Rate for Payer: Cash Price |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$258.02
|
| Rate for Payer: Cofinity Commercial |
$317.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.88
|
| Rate for Payer: Healthscope Commercial |
$331.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.31
|
| Rate for Payer: PHP Commercial |
$313.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.59
|
| Rate for Payer: Priority Health SBD |
$232.22
|
| Rate for Payer: UMR Bronson Commercial |
$162.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.45
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 60687059011
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
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 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 (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 |
$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 (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$45.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.23 |
| Max. Negotiated Rate |
$41.38 |
| Rate for Payer: Aetna American Axle |
$29.89
|
| Rate for Payer: Aetna American Axle |
$14.07
|
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna American Axle |
$210.10
|
| Rate for Payer: Aetna American Axle |
$19.85
|
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna Commercial |
$25.96
|
| Rate for Payer: Aetna Commercial |
$39.08
|
| Rate for Payer: Aetna Commercial |
$274.75
|
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$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) |
$50.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.89
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Cofinity Commercial |
$39.54
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Cofinity Commercial |
$226.26
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$32.19
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.58
|
| Rate for Payer: Healthscope Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$290.91
|
| Rate for Payer: Healthscope Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.19
|
| 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 |
$54.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| 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 |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.08
|
| 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: Multiplan/Beech St/PHCS Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$39.08
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$18.40
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: PHP Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$25.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.36
|
| Rate for Payer: Priority Health SBD |
$13.64
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$203.63
|
| Rate for Payer: Priority Health SBD |
$19.24
|
| Rate for Payer: Priority Health SBD |
$28.97
|
| Rate for Payer: UMR Bronson Commercial |
$20.23
|
| Rate for Payer: UMR Bronson Commercial |
$34.09
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: UMR Bronson Commercial |
$17.82
|
| Rate for Payer: UMR Bronson Commercial |
$142.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
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 |
$14.98 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$19.85
|
| Rate for Payer: Aetna American Axle |
$14.07
|
| Rate for Payer: Aetna American Axle |
$29.89
|
| Rate for Payer: Aetna American Axle |
$210.10
|
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$25.96
|
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: Aetna Commercial |
$39.08
|
| Rate for Payer: Aetna Commercial |
$274.75
|
| Rate for Payer: Aetna Medicare |
$161.62
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Aetna Medicare |
$22.99
|
| Rate for Payer: Aetna Medicare |
$38.74
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Aetna Medicare |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.89
|
| 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) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: BCBS Complete |
$30.99
|
| Rate for Payer: BCBS Complete |
$16.20
|
| Rate for Payer: BCBS Complete |
$12.22
|
| Rate for Payer: BCBS Complete |
$129.29
|
| Rate for Payer: BCBS Complete |
$18.39
|
| Rate for Payer: BCBS Complete |
$8.66
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Cofinity Commercial |
$226.26
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$26.26
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$39.54
|
| Rate for Payer: Cofinity Commercial |
$32.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.43
|
| 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 |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$290.91
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$41.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| 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 |
$15.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.40
|
| 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 |
$39.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$18.40
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: PHP Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$25.96
|
| Rate for Payer: PHP Commercial |
$39.08
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.10
|
| Rate for Payer: Priority Health SBD |
$19.24
|
| Rate for Payer: Priority Health SBD |
$28.97
|
| Rate for Payer: Priority Health SBD |
$203.63
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$13.64
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$28.67
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.30
|
| Rate for Payer: UMR Bronson Commercial |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$17.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.91
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
117123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.92
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.91
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
117123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna Medicare |
$9.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.92
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
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 Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
