|
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) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$323.23
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$290.91 |
| Rate for Payer: Aetna American Axle |
$210.10
|
| Rate for Payer: Aetna American Axle |
$26.32
|
| Rate for Payer: Aetna American Axle |
$19.85
|
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna American Axle |
$29.89
|
| Rate for Payer: Aetna American Axle |
$14.07
|
| Rate for Payer: Aetna Commercial |
$274.75
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: Aetna Commercial |
$18.40
|
| Rate for Payer: Aetna Commercial |
$25.96
|
| Rate for Payer: Aetna Commercial |
$39.08
|
| 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 Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.10
|
| 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: 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: 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 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 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: 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 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: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$258.58
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$32.19
|
| 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 |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Cofinity Commercial |
$28.35
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Cofinity Commercial |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$226.26
|
| Rate for Payer: Cofinity Commercial |
$277.98
|
| Rate for Payer: Cofinity Commercial |
$39.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.43
|
| 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: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$290.91
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Healthscope Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$41.38
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.19
|
| 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: 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 |
$22.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| 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 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: 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 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: 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: 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 |
$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 |
$25.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.75
|
| 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: 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 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: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$39.08
|
| Rate for Payer: PHP Commercial |
$25.96
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: PHP Commercial |
$18.40
|
| Rate for Payer: PHP Commercial |
$274.75
|
| Rate for Payer: PHP Commercial |
$34.42
|
| 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: 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 Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.85
|
| 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 |
$50.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| 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 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 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 Narrow Network |
$0.21
|
| Rate for Payer: Priority Health Narrow Network |
$0.21
|
| Rate for Payer: Priority Health SBD |
$203.63
|
| Rate for Payer: Priority Health SBD |
$28.97
|
| Rate for Payer: Priority Health SBD |
$25.52
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: Priority Health SBD |
$13.64
|
| Rate for Payer: Priority Health SBD |
$19.24
|
| 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: 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 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 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 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: 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: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UMR Bronson Commercial |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.30
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$17.01
|
| Rate for Payer: UMR Bronson Commercial |
$28.67
|
| 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: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.48
|
| 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 |
$58.11
|
|
|
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 |
$15.16
|
| 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 |
$15.16
|
| 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 |
$15.16
|
| 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 |
$22.90
|
| 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 |
$22.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
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 |
$0.05 |
| 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 |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| 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 |
$15.93
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| 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: 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 |
$16.92
|
| 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 |
$16.92
|
| 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 |
$12.94
|
| 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 |
$12.54
|
| 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 |
$7.37
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
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 VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| 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 |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| 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 |
$11.26
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| 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: 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 |
$11.96
|
| 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 |
$11.96
|
| 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 |
$9.15
|
| 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 |
$8.86
|
| 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 |
$5.21
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
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
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,970.05
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,306.82 |
| Max. Negotiated Rate |
$2,673.04 |
| Rate for Payer: Aetna American Axle |
$1,930.53
|
| Rate for Payer: Aetna Commercial |
$2,524.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,930.53
|
| Rate for Payer: Cash Price |
$2,376.04
|
| Rate for Payer: Cofinity Commercial |
$2,079.04
|
| Rate for Payer: Cofinity Commercial |
$2,554.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,079.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,376.04
|
| Rate for Payer: Healthscope Commercial |
$2,673.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,079.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,227.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,524.54
|
| Rate for Payer: PHP Commercial |
$2,524.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,930.53
|
| Rate for Payer: Priority Health SBD |
$1,871.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,306.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,227.54
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,970.05
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$2,673.04 |
| Rate for Payer: Aetna American Axle |
$1,930.53
|
| Rate for Payer: Aetna Commercial |
$2,524.54
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,930.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$13.47
|
| Rate for Payer: BCN Commercial |
$13.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$2,376.04
|
| Rate for Payer: Cash Price |
$2,376.04
|
| Rate for Payer: Cofinity Commercial |
$2,554.24
|
| Rate for Payer: Cofinity Commercial |
$2,079.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,079.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,376.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$2,673.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,079.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,227.54
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicare |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,524.54
|
| Rate for Payer: Nomi Health Commercial |
$15.54
|
| Rate for Payer: PACE Medicare |
$4.92
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$2,524.54
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,930.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.47
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow Network |
$11.58
|
| Rate for Payer: Priority Health SBD |
$1,871.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$9.90
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,098.92
|
| Rate for Payer: VA VA |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,227.54
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
NDC 63304029601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.58 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna Medicare |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: BCBS Complete |
$97.92
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UMR Bronson Commercial |
$90.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.22 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.08
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$306.72
|
|
|
Service Code
|
NDC 68382009601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna American Axle |
$199.37
|
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.37
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: UMR Bronson Commercial |
$134.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.04
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
NDC 63304029601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.71 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna American Axle |
$159.12
|
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Commercial |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.12
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.60
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$1,456.80
|
|
|
Service Code
|
NDC 68382009605
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$539.02 |
| Max. Negotiated Rate |
$1,311.12 |
| Rate for Payer: Aetna American Axle |
$946.92
|
| Rate for Payer: Aetna Commercial |
$1,238.28
|
| Rate for Payer: Aetna Medicare |
$728.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.92
|
| Rate for Payer: BCBS Complete |
$582.72
|
| Rate for Payer: Cash Price |
$1,165.44
|
| Rate for Payer: Cofinity Commercial |
$1,019.76
|
| Rate for Payer: Cofinity Commercial |
$1,252.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,019.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.44
|
| Rate for Payer: Healthscope Commercial |
$1,311.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,238.28
|
| Rate for Payer: PHP Commercial |
$1,238.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.92
|
| Rate for Payer: Priority Health SBD |
$917.78
|
| Rate for Payer: UMR Bronson Commercial |
$539.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.60
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$576.96
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.86 |
| Max. Negotiated Rate |
$519.26 |
| Rate for Payer: Aetna American Axle |
$375.02
|
| Rate for Payer: Aetna Commercial |
$490.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.02
|
| Rate for Payer: Cash Price |
$461.57
|
| Rate for Payer: Cofinity Commercial |
$403.87
|
| Rate for Payer: Cofinity Commercial |
$496.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.57
|
| Rate for Payer: Healthscope Commercial |
$519.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.42
|
| Rate for Payer: PHP Commercial |
$490.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.02
|
| Rate for Payer: Priority Health SBD |
$363.48
|
| Rate for Payer: UMR Bronson Commercial |
$253.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.72
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$379.68
|
|
|
Service Code
|
NDC 00781599401
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna Medicare |
$189.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: BCBS Complete |
$151.87
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.79
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$140.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$195.12
|
|
|
Service Code
|
NDC 00904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$175.61 |
| Rate for Payer: Aetna American Axle |
$126.83
|
| Rate for Payer: Aetna Commercial |
$165.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.83
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$136.58
|
| Rate for Payer: Cofinity Commercial |
$167.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Healthscope Commercial |
$175.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.85
|
| Rate for Payer: PHP Commercial |
$165.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: Priority Health SBD |
$122.93
|
| Rate for Payer: UMR Bronson Commercial |
$85.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.34
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$306.72
|
|
|
Service Code
|
NDC 68382009601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.49 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna American Axle |
$199.37
|
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna Medicare |
$153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: BCBS Complete |
$122.69
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.37
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: UMR Bronson Commercial |
$113.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.04
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$1,456.80
|
|
|
Service Code
|
NDC 68382009605
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$640.99 |
| Max. Negotiated Rate |
$1,311.12 |
| Rate for Payer: Aetna American Axle |
$946.92
|
| Rate for Payer: Aetna Commercial |
$1,238.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.92
|
| Rate for Payer: Cash Price |
$1,165.44
|
| Rate for Payer: Cofinity Commercial |
$1,019.76
|
| Rate for Payer: Cofinity Commercial |
$1,252.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,019.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,165.44
|
| Rate for Payer: Healthscope Commercial |
$1,311.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,019.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,092.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,238.28
|
| Rate for Payer: PHP Commercial |
$1,238.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$946.92
|
| Rate for Payer: Priority Health SBD |
$917.78
|
| Rate for Payer: UMR Bronson Commercial |
$640.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,092.60
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$195.12
|
|
|
Service Code
|
NDC 00904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.19 |
| Max. Negotiated Rate |
$175.61 |
| Rate for Payer: Aetna American Axle |
$126.83
|
| Rate for Payer: Aetna Commercial |
$165.85
|
| Rate for Payer: Aetna Medicare |
$97.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.83
|
| Rate for Payer: BCBS Complete |
$78.05
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$136.58
|
| Rate for Payer: Cofinity Commercial |
$167.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Healthscope Commercial |
$175.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.85
|
| Rate for Payer: PHP Commercial |
$165.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: Priority Health SBD |
$122.93
|
| Rate for Payer: UMR Bronson Commercial |
$72.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.34
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.94 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna American Axle |
$179.08
|
| Rate for Payer: Aetna Commercial |
$234.18
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.08
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$192.85
|
| Rate for Payer: Cofinity Commercial |
$236.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$247.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: PHP Commercial |
$234.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health SBD |
$173.56
|
| Rate for Payer: UMR Bronson Commercial |
$101.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.62
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$576.96
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.48 |
| Max. Negotiated Rate |
$519.26 |
| Rate for Payer: Aetna American Axle |
$375.02
|
| Rate for Payer: Aetna Commercial |
$490.42
|
| Rate for Payer: Aetna Medicare |
$288.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.02
|
| Rate for Payer: BCBS Complete |
$230.78
|
| Rate for Payer: Cash Price |
$461.57
|
| Rate for Payer: Cofinity Commercial |
$403.87
|
| Rate for Payer: Cofinity Commercial |
$496.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$403.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$461.57
|
| Rate for Payer: Healthscope Commercial |
$519.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$403.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$432.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$490.42
|
| Rate for Payer: PHP Commercial |
$490.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.02
|
| Rate for Payer: Priority Health SBD |
$363.48
|
| Rate for Payer: UMR Bronson Commercial |
$213.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$432.72
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$379.68
|
|
|
Service Code
|
NDC 00781599401
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$341.71 |
| Rate for Payer: Aetna American Axle |
$246.79
|
| Rate for Payer: Aetna Commercial |
$322.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.79
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cofinity Commercial |
$265.78
|
| Rate for Payer: Cofinity Commercial |
$326.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$265.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$303.74
|
| Rate for Payer: Healthscope Commercial |
$341.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$265.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$284.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.73
|
| Rate for Payer: PHP Commercial |
$322.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.79
|
| Rate for Payer: Priority Health SBD |
$239.20
|
| Rate for Payer: UMR Bronson Commercial |
$167.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$284.76
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 69315016401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UMR Bronson Commercial |
$110.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna American Axle |
$162.55
|
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.55
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$175.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$175.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.55
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: UMR Bronson Commercial |
$110.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
