|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna American Axle |
$5.14
|
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.14
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health SBD |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
IP
|
$249.08
|
|
|
Service Code
|
NDC 38779000904
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.17 |
| Rate for Payer: Aetna American Axle |
$161.90
|
| Rate for Payer: Aetna Commercial |
$211.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.90
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$174.36
|
| Rate for Payer: Cofinity Commercial |
$214.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.72
|
| Rate for Payer: PHP Commercial |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: Priority Health SBD |
$156.92
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.81
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
OP
|
$249.08
|
|
|
Service Code
|
NDC 38779000904
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.16 |
| Max. Negotiated Rate |
$224.17 |
| Rate for Payer: Aetna American Axle |
$161.90
|
| Rate for Payer: Aetna Commercial |
$211.72
|
| Rate for Payer: Aetna Medicare |
$124.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.90
|
| Rate for Payer: BCBS Complete |
$99.63
|
| Rate for Payer: Cash Price |
$199.26
|
| Rate for Payer: Cofinity Commercial |
$174.36
|
| Rate for Payer: Cofinity Commercial |
$214.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.26
|
| Rate for Payer: Healthscope Commercial |
$224.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.72
|
| Rate for Payer: PHP Commercial |
$211.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.90
|
| Rate for Payer: Priority Health SBD |
$156.92
|
| Rate for Payer: UMR Bronson Commercial |
$92.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.81
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
IP
|
$295.09
|
|
|
Service Code
|
NDC 00574042025
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna American Axle |
$191.81
|
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.81
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.83
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.81
|
| Rate for Payer: Priority Health SBD |
$185.91
|
| Rate for Payer: UMR Bronson Commercial |
$129.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.32
|
|
|
HYDROCORTISONE (BULK) POWDER
|
Facility
|
OP
|
$295.09
|
|
|
Service Code
|
NDC 00574042025
|
| Hospital Charge Code |
3735
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.18 |
| Max. Negotiated Rate |
$265.58 |
| Rate for Payer: Aetna American Axle |
$191.81
|
| Rate for Payer: Aetna Commercial |
$250.83
|
| Rate for Payer: Aetna Medicare |
$147.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.81
|
| Rate for Payer: BCBS Complete |
$118.04
|
| Rate for Payer: Cash Price |
$236.07
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Cofinity Commercial |
$253.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.07
|
| Rate for Payer: Healthscope Commercial |
$265.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.83
|
| Rate for Payer: PHP Commercial |
$250.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.81
|
| Rate for Payer: Priority Health SBD |
$185.91
|
| Rate for Payer: UMR Bronson Commercial |
$109.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.32
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$78.06
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$70.25 |
| Rate for Payer: Aetna American Axle |
$50.74
|
| Rate for Payer: Aetna Commercial |
$66.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.74
|
| Rate for Payer: Cash Price |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$54.64
|
| Rate for Payer: Cofinity Commercial |
$67.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.45
|
| Rate for Payer: Healthscope Commercial |
$70.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.35
|
| Rate for Payer: PHP Commercial |
$66.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.74
|
| Rate for Payer: Priority Health SBD |
$49.18
|
| Rate for Payer: UMR Bronson Commercial |
$34.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.54
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$78.06
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.88 |
| Max. Negotiated Rate |
$70.25 |
| Rate for Payer: Aetna American Axle |
$50.74
|
| Rate for Payer: Aetna Commercial |
$66.35
|
| Rate for Payer: Aetna Medicare |
$39.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.74
|
| Rate for Payer: BCBS Complete |
$31.22
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$62.45
|
| Rate for Payer: Cash Price |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$54.64
|
| Rate for Payer: Cofinity Commercial |
$67.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.45
|
| Rate for Payer: Healthscope Commercial |
$70.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.35
|
| Rate for Payer: PHP Commercial |
$66.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.74
|
| Rate for Payer: Priority Health SBD |
$49.18
|
| Rate for Payer: UMR Bronson Commercial |
$28.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.54
|
|
|
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 |
$73.18
|
| 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 |
$73.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.76
|
|
|
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 |
$83.60
|
| Rate for Payer: Aetna Commercial |
$82.94
|
| Rate for Payer: Aetna Medicare |
$48.79
|
| Rate for Payer: Aetna Medicare |
$49.18
|
| 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: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$78.68
|
| Rate for Payer: Cash Price |
$78.68
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$84.58
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Cofinity Commercial |
$68.84
|
| 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 |
$78.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$88.52
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.18
|
| 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 |
$82.94
|
| Rate for Payer: PHP Commercial |
$83.60
|
| 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 |
$73.18
|
|
|
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 |
$52.29 |
| 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 |
$155.50
|
| Rate for Payer: Aetna Commercial |
$153.45
|
| Rate for Payer: Aetna Medicare |
$90.26
|
| 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: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cash Price |
$144.42
|
| Rate for Payer: Cofinity Commercial |
$157.33
|
| Rate for Payer: Cofinity Commercial |
$126.37
|
| Rate for Payer: Cofinity Commercial |
$128.06
|
| 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 |
$146.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$164.65
|
| Rate for Payer: Healthscope Commercial |
$162.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.40
|
| 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 |
$153.45
|
| Rate for Payer: PHP Commercial |
$155.50
|
| 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 |
$137.20
|
| 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 |
$137.20
|
| 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 |
$137.20
|
|
|
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 |
$0.05 |
| 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 |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$86.00
|
| Rate for Payer: Cofinity Commercial |
$70.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| 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: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$21.41
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna American Axle |
$13.92
|
| Rate for Payer: Aetna American Axle |
$10.71
|
| Rate for Payer: Aetna American Axle |
$9.15
|
| Rate for Payer: Aetna American Axle |
$10.01
|
| 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 Commercial |
$14.01
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| 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) |
$10.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$10.78
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| 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 |
$16.06
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| 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 |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.01
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| 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 Cigna Priority Health |
$13.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| 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: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$6.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.70
|
| Rate for Payer: UMR Bronson Commercial |
$5.21
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
|
|
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 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 AVERAGE PCA IV SOLUTION 50 ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna American Axle |
$50.70
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| 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 Commercial |
$67.08
|
| 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: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| 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 HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: UMR Bronson Commercial |
$28.86
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.50
|
|
|
HYDROMORPHONE 10 MG/50 ML (0.2 MG/ML) ADULT TOLERANT PCA IV SOLUTION 50 ML
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
301641
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna American Axle |
$65.00
|
| Rate for Payer: Aetna American Axle |
$50.70
|
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$80.00
|
| 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 Commercial |
$67.08
|
| 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: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$70.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.50
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$85.00
|
| Rate for Payer: PHP Commercial |
$66.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| 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 HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$63.00
|
| Rate for Payer: Priority Health SBD |
$49.14
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$37.00
|
| Rate for Payer: UMR Bronson Commercial |
$28.86
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| 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 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$31.97
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$28.77 |
| Rate for Payer: Aetna American Axle |
$20.78
|
| Rate for Payer: Aetna American Axle |
$18.24
|
| Rate for Payer: Aetna American Axle |
$11.09
|
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Aetna Commercial |
$14.50
|
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| 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: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.21
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$24.13
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$25.25
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| 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 |
$14.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: Nomi Health Commercial |
$0.27
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$14.50
|
| Rate for Payer: PHP Commercial |
$23.85
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.26
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$20.14
|
| Rate for Payer: Priority Health SBD |
$10.75
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: UMR Bronson Commercial |
$8.09
|
| Rate for Payer: UMR Bronson Commercial |
$6.31
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
|
|
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 |
$21.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.80
|
| 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 |
$12.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.04
|
|
|
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
|
$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
|
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 |
$2,830.90
|
| 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 |
$2,830.90
|
|
|
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
|
|
