|
MONTELUKAST 4 MG ORAL GRANULES IN PACKET
|
Facility
|
OP
|
$15.68
|
|
|
Service Code
|
NDC 55111076307
|
| Hospital Charge Code |
36023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$14.11 |
| Rate for Payer: Aetna American Axle |
$10.19
|
| Rate for Payer: Aetna Commercial |
$13.33
|
| Rate for Payer: Aetna Medicare |
$7.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.19
|
| Rate for Payer: BCBS Complete |
$6.27
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cofinity Commercial |
$10.98
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.54
|
| Rate for Payer: Healthscope Commercial |
$14.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.33
|
| Rate for Payer: PHP Commercial |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.19
|
| Rate for Payer: Priority Health SBD |
$9.88
|
| Rate for Payer: UMR Bronson Commercial |
$5.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.76
|
|
|
MONTELUKAST 4 MG ORAL GRANULES IN PACKET
|
Facility
|
IP
|
$784.66
|
|
|
Service Code
|
NDC 00006384130
|
| Hospital Charge Code |
36023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.25 |
| Max. Negotiated Rate |
$706.19 |
| Rate for Payer: Aetna American Axle |
$510.03
|
| Rate for Payer: Aetna Commercial |
$666.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.03
|
| Rate for Payer: Cash Price |
$627.73
|
| Rate for Payer: Cofinity Commercial |
$549.26
|
| Rate for Payer: Cofinity Commercial |
$674.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$549.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.73
|
| Rate for Payer: Healthscope Commercial |
$706.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$549.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$588.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.96
|
| Rate for Payer: PHP Commercial |
$666.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.03
|
| Rate for Payer: Priority Health SBD |
$494.34
|
| Rate for Payer: UMR Bronson Commercial |
$345.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$588.50
|
|
|
MONTELUKAST 5 MG CHEWABLE TABLET
|
Facility
|
IP
|
$88.35
|
|
|
Service Code
|
NDC 13668008030
|
| Hospital Charge Code |
22510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$38.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
MONTELUKAST 5 MG CHEWABLE TABLET
|
Facility
|
OP
|
$88.35
|
|
|
Service Code
|
NDC 13668008030
|
| Hospital Charge Code |
22510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.69 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna American Axle |
$57.43
|
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna Medicare |
$44.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.43
|
| Rate for Payer: BCBS Complete |
$35.34
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$61.84
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health SBD |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$32.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
MONTELUKAST 5 MG CHEWABLE TABLET
|
Facility
|
OP
|
$76.14
|
|
|
Service Code
|
NDC 33342011107
|
| Hospital Charge Code |
22510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna Medicare |
$38.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: BCBS Complete |
$30.46
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Commercial |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.49
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$28.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
MONTELUKAST 5 MG CHEWABLE TABLET
|
Facility
|
IP
|
$76.14
|
|
|
Service Code
|
NDC 33342011107
|
| Hospital Charge Code |
22510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Commercial |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.49
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
MORPHINE 0.1 MG/ML INJECTION (NICU)
|
Facility
|
OP
|
$16.39
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
500539
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: Aetna Medicare |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: BCBS Complete |
$6.56
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$14.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: PHP Commercial |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.33
|
| Rate for Payer: UMR Bronson Commercial |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
MORPHINE 0.1 MG/ML INJECTION (NICU)
|
Facility
|
IP
|
$16.39
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
500539
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$14.75 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: Cash Price |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.11
|
| Rate for Payer: Healthscope Commercial |
$14.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.93
|
| Rate for Payer: PHP Commercial |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 09900000428
|
| Hospital Charge Code |
165001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna American Axle |
$0.36
|
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.36
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.39
|
| Rate for Payer: Cofinity Commercial |
$0.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$0.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.47
|
| Rate for Payer: PHP Commercial |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.36
|
| Rate for Payer: Priority Health SBD |
$0.35
|
| Rate for Payer: UMR Bronson Commercial |
$0.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.41
|
|
|
MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 09900000428
|
| Hospital Charge Code |
165001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna American Axle |
$0.36
|
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: Aetna Medicare |
$0.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.36
|
| Rate for Payer: BCBS Complete |
$0.22
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.39
|
| Rate for Payer: Cofinity Commercial |
$0.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.44
|
| Rate for Payer: Healthscope Commercial |
$0.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.47
|
| Rate for Payer: PHP Commercial |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.36
|
| Rate for Payer: Priority Health SBD |
$0.35
|
| Rate for Payer: UMR Bronson Commercial |
$0.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.41
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna American Axle |
$52.65
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: UMR Bronson Commercial |
$35.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna American Axle |
$52.65
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: UMR Bronson Commercial |
$29.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML PCA IV SOLUTION
|
Facility
|
IP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna American Axle |
$147.87
|
| Rate for Payer: Aetna American Axle |
$52.65
|
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: UMR Bronson Commercial |
$100.10
|
| Rate for Payer: UMR Bronson Commercial |
$35.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML PCA IV SOLUTION
|
Facility
|
OP
|
$227.49
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
150918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.17 |
| Max. Negotiated Rate |
$204.74 |
| Rate for Payer: Aetna American Axle |
$147.87
|
| Rate for Payer: Aetna American Axle |
$52.65
|
| Rate for Payer: Aetna Commercial |
$193.37
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$91.00
|
| Rate for Payer: Cash Price |
$181.99
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$195.64
|
| Rate for Payer: Cofinity Commercial |
$159.24
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$159.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Healthscope Commercial |
$204.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$193.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UMR Bronson Commercial |
$84.17
|
| Rate for Payer: UMR Bronson Commercial |
$29.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
MORPHINE 100MG/100ML TOLERANT PCA IV SOLUTION
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna American Axle |
$52.65
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: UMR Bronson Commercial |
$35.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 100MG/100ML TOLERANT PCA IV SOLUTION
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
190325
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Aetna American Axle |
$52.65
|
| Rate for Payer: Aetna Commercial |
$68.85
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$56.70
|
| Rate for Payer: Cofinity Commercial |
$69.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.80
|
| Rate for Payer: Healthscope Commercial |
$72.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.85
|
| Rate for Payer: PHP Commercial |
$68.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health SBD |
$51.03
|
| Rate for Payer: UMR Bronson Commercial |
$29.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.75
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 62559017001
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$376.25
|
|
|
Service Code
|
NDC 00054023763
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.55 |
| Max. Negotiated Rate |
$338.62 |
| Rate for Payer: Aetna American Axle |
$244.56
|
| Rate for Payer: Aetna Commercial |
$319.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Commercial |
$323.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$301.00
|
| Rate for Payer: Healthscope Commercial |
$338.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.81
|
| Rate for Payer: PHP Commercial |
$319.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.56
|
| Rate for Payer: Priority Health SBD |
$237.04
|
| Rate for Payer: UMR Bronson Commercial |
$165.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.19
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$148.75
|
|
|
Service Code
|
NDC 00054023749
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna Medicare |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: BCBS Complete |
$59.50
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.69
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$55.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 00054023749
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.69
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$65.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 62559017001
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
NDC 00990000103
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna American Axle |
$4.84
|
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$5.21
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.84
|
| Rate for Payer: Priority Health SBD |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
NDC 00990000103
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna American Axle |
$4.84
|
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$5.21
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.84
|
| Rate for Payer: Priority Health SBD |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$0.75
|
|
|
Service Code
|
NDC 09900000030
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna American Axle |
$0.49
|
| Rate for Payer: Aetna Commercial |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.49
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cofinity Commercial |
$0.53
|
| Rate for Payer: Cofinity Commercial |
$0.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.60
|
| Rate for Payer: Healthscope Commercial |
$0.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.64
|
| Rate for Payer: PHP Commercial |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.49
|
| Rate for Payer: Priority Health SBD |
$0.47
|
| Rate for Payer: UMR Bronson Commercial |
$0.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.56
|
|
|
MORPHINE 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$0.75
|
|
|
Service Code
|
NDC 09900000030
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna American Axle |
$0.49
|
| Rate for Payer: Aetna Commercial |
$0.64
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.49
|
| Rate for Payer: BCBS Complete |
$0.30
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cofinity Commercial |
$0.53
|
| Rate for Payer: Cofinity Commercial |
$0.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.60
|
| Rate for Payer: Healthscope Commercial |
$0.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.64
|
| Rate for Payer: PHP Commercial |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.49
|
| Rate for Payer: Priority Health SBD |
$0.47
|
| Rate for Payer: UMR Bronson Commercial |
$0.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.56
|
|
