|
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 |
$323.58
|
| 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
|
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
|
$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
|
$376.25
|
|
|
Service Code
|
NDC 00054023763
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.21 |
| Max. Negotiated Rate |
$338.62 |
| Rate for Payer: Aetna American Axle |
$244.56
|
| Rate for Payer: Aetna Commercial |
$319.81
|
| Rate for Payer: Aetna Medicare |
$188.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.56
|
| Rate for Payer: BCBS Complete |
$150.50
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Commercial |
$323.58
|
| 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 |
$139.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.19
|
|
|
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
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 00990000102
|
| Hospital Charge Code |
5176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
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/ML INJECTION SOLUTION
|
Facility
|
OP
|
$33.73
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna American Axle |
$21.92
|
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna Medicare |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: BCBS Complete |
$13.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.66
|
| Rate for Payer: BCN Commercial |
$13.66
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cofinity Commercial |
$23.61
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.98
|
| Rate for Payer: Healthscope Commercial |
$30.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.67
|
| Rate for Payer: PHP Commercial |
$28.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.92
|
| Rate for Payer: Priority Health SBD |
$21.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.30
|
|
|
MORPHINE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$33.73
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
5168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna American Axle |
$21.92
|
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.92
|
| Rate for Payer: Cash Price |
$26.98
|
| Rate for Payer: Cofinity Commercial |
$23.61
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.98
|
| Rate for Payer: Healthscope Commercial |
$30.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.67
|
| Rate for Payer: PHP Commercial |
$28.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.92
|
| Rate for Payer: Priority Health SBD |
$21.25
|
| Rate for Payer: UMR Bronson Commercial |
$14.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.30
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.47
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.47
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
27390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Medicare |
$8.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.36
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: UMR Bronson Commercial |
$6.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$29.17
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
172788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.79 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna American Axle |
$18.96
|
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna Medicare |
$14.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.96
|
| Rate for Payer: BCBS Complete |
$11.67
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$23.34
|
| Rate for Payer: Cash Price |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$25.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.34
|
| Rate for Payer: Healthscope Commercial |
$26.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.79
|
| Rate for Payer: PHP Commercial |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.96
|
| Rate for Payer: Priority Health SBD |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.88
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$29.17
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
172788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna American Axle |
$18.96
|
| Rate for Payer: Aetna Commercial |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.96
|
| Rate for Payer: Cash Price |
$23.34
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$25.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.34
|
| Rate for Payer: Healthscope Commercial |
$26.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.79
|
| Rate for Payer: PHP Commercial |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.96
|
| Rate for Payer: Priority Health SBD |
$18.38
|
| Rate for Payer: UMR Bronson Commercial |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.88
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
IP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna American Axle |
$10.74
|
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health SBD |
$10.41
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.39
|
|
|
MORPHINE 10 MG/ML SYRINGE (CODE)
|
Facility
|
OP
|
$16.52
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
163726
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$14.87 |
| Rate for Payer: Aetna American Axle |
$10.74
|
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.74
|
| Rate for Payer: BCBS Complete |
$6.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCN Commercial |
$13.05
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cash Price |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$14.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$14.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.04
|
| Rate for Payer: PHP Commercial |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.74
|
| Rate for Payer: Priority Health SBD |
$10.41
|
| Rate for Payer: UMR Bronson Commercial |
$6.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.39
|
|
|
MORPHINE 10 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$228.67
|
|
|
Service Code
|
NDC 00574711212
|
| Hospital Charge Code |
5180
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.61 |
| Max. Negotiated Rate |
$205.80 |
| Rate for Payer: Aetna American Axle |
$148.64
|
| Rate for Payer: Aetna Commercial |
$194.37
|
| Rate for Payer: Aetna Medicare |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.64
|
| Rate for Payer: BCBS Complete |
$91.47
|
| Rate for Payer: Cash Price |
$182.94
|
| Rate for Payer: Cofinity Commercial |
$160.07
|
| Rate for Payer: Cofinity Commercial |
$196.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.94
|
| Rate for Payer: Healthscope Commercial |
$205.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.37
|
| Rate for Payer: PHP Commercial |
$194.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.64
|
| Rate for Payer: Priority Health SBD |
$144.06
|
| Rate for Payer: UMR Bronson Commercial |
$84.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.50
|
|
|
MORPHINE 10 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$228.67
|
|
|
Service Code
|
NDC 00574711212
|
| Hospital Charge Code |
5180
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.61 |
| Max. Negotiated Rate |
$205.80 |
| Rate for Payer: Aetna American Axle |
$148.64
|
| Rate for Payer: Aetna Commercial |
$194.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.64
|
| Rate for Payer: Cash Price |
$182.94
|
| Rate for Payer: Cofinity Commercial |
$160.07
|
| Rate for Payer: Cofinity Commercial |
$196.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.94
|
| Rate for Payer: Healthscope Commercial |
$205.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$194.37
|
| Rate for Payer: PHP Commercial |
$194.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.64
|
| Rate for Payer: Priority Health SBD |
$144.06
|
| Rate for Payer: UMR Bronson Commercial |
$100.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.50
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$123.38
|
|
|
Service Code
|
NDC 00054023524
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$111.04 |
| Rate for Payer: Aetna American Axle |
$80.20
|
| Rate for Payer: Aetna Commercial |
$104.87
|
| Rate for Payer: Aetna Medicare |
$61.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.20
|
| Rate for Payer: BCBS Complete |
$49.35
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$106.11
|
| Rate for Payer: Cofinity Commercial |
$86.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$111.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.87
|
| Rate for Payer: PHP Commercial |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.20
|
| Rate for Payer: Priority Health SBD |
$77.73
|
| Rate for Payer: UMR Bronson Commercial |
$45.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.54
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$4.94
|
|
|
Service Code
|
NDC 00406511823
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna American Axle |
$3.21
|
| Rate for Payer: Aetna Commercial |
$4.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.21
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.95
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.20
|
| Rate for Payer: PHP Commercial |
$4.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.21
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: UMR Bronson Commercial |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$703.50
|
|
|
Service Code
|
NDC 51862061501
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.54 |
| Max. Negotiated Rate |
$633.15 |
| Rate for Payer: Aetna American Axle |
$457.28
|
| Rate for Payer: Aetna Commercial |
$597.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.28
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cofinity Commercial |
$492.45
|
| Rate for Payer: Cofinity Commercial |
$605.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$492.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.80
|
| Rate for Payer: Healthscope Commercial |
$633.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$597.98
|
| Rate for Payer: PHP Commercial |
$597.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.28
|
| Rate for Payer: Priority Health SBD |
$443.20
|
| Rate for Payer: UMR Bronson Commercial |
$309.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.62
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$703.50
|
|
|
Service Code
|
NDC 51862061501
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.30 |
| Max. Negotiated Rate |
$633.15 |
| Rate for Payer: Aetna American Axle |
$457.28
|
| Rate for Payer: Aetna Commercial |
$597.98
|
| Rate for Payer: Aetna Medicare |
$351.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.28
|
| Rate for Payer: BCBS Complete |
$281.40
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cofinity Commercial |
$492.45
|
| Rate for Payer: Cofinity Commercial |
$605.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$492.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.80
|
| Rate for Payer: Healthscope Commercial |
$633.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$597.98
|
| Rate for Payer: PHP Commercial |
$597.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.28
|
| Rate for Payer: Priority Health SBD |
$443.20
|
| Rate for Payer: UMR Bronson Commercial |
$260.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.62
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$535.50
|
|
|
Service Code
|
NDC 00054023525
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.14 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna American Axle |
$348.08
|
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.08
|
| Rate for Payer: BCBS Complete |
$214.20
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health SBD |
$337.36
|
| Rate for Payer: UMR Bronson Commercial |
$198.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.62
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$535.50
|
|
|
Service Code
|
NDC 00054023525
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.62 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna American Axle |
$348.08
|
| Rate for Payer: Aetna Commercial |
$455.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.08
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$374.85
|
| Rate for Payer: Cofinity Commercial |
$460.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$374.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$428.40
|
| Rate for Payer: Healthscope Commercial |
$481.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$374.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$401.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$455.18
|
| Rate for Payer: PHP Commercial |
$455.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.08
|
| Rate for Payer: Priority Health SBD |
$337.36
|
| Rate for Payer: UMR Bronson Commercial |
$235.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$401.62
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$493.50
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.14 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna American Axle |
$320.78
|
| Rate for Payer: Aetna Commercial |
$419.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.78
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cofinity Commercial |
$345.45
|
| Rate for Payer: Cofinity Commercial |
$424.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.80
|
| Rate for Payer: Healthscope Commercial |
$444.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.48
|
| Rate for Payer: PHP Commercial |
$419.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health SBD |
$310.90
|
| Rate for Payer: UMR Bronson Commercial |
$217.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.12
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$493.50
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna American Axle |
$320.78
|
| Rate for Payer: Aetna Commercial |
$419.48
|
| Rate for Payer: Aetna Medicare |
$246.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.78
|
| Rate for Payer: BCBS Complete |
$197.40
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cofinity Commercial |
$345.45
|
| Rate for Payer: Cofinity Commercial |
$424.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.80
|
| Rate for Payer: Healthscope Commercial |
$444.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.48
|
| Rate for Payer: PHP Commercial |
$419.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health SBD |
$310.90
|
| Rate for Payer: UMR Bronson Commercial |
$182.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.12
|
|
