|
MORPHINE 7.5 MG IMMEDIATE RELEASE CUSTOM TABLET
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 09900001130
|
| Hospital Charge Code |
300182
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
MORPHINE (BULK) 100 % POWDER
|
Facility
|
IP
|
$110.39
|
|
|
Service Code
|
NDC 00406152153
|
| Hospital Charge Code |
5184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$99.35 |
| Rate for Payer: Aetna American Axle |
$71.75
|
| Rate for Payer: Aetna Commercial |
$93.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.75
|
| Rate for Payer: Cash Price |
$88.31
|
| Rate for Payer: Cofinity Commercial |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.31
|
| Rate for Payer: Healthscope Commercial |
$99.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.83
|
| Rate for Payer: PHP Commercial |
$93.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.75
|
| Rate for Payer: Priority Health SBD |
$69.55
|
| Rate for Payer: UMR Bronson Commercial |
$48.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.79
|
|
|
MORPHINE (BULK) 100 % POWDER
|
Facility
|
OP
|
$110.39
|
|
|
Service Code
|
NDC 00406152153
|
| Hospital Charge Code |
5184
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$99.35 |
| Rate for Payer: Aetna American Axle |
$71.75
|
| Rate for Payer: Aetna Commercial |
$93.83
|
| Rate for Payer: Aetna Medicare |
$55.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.75
|
| Rate for Payer: BCBS Complete |
$44.16
|
| Rate for Payer: Cash Price |
$88.31
|
| Rate for Payer: Cofinity Commercial |
$77.27
|
| Rate for Payer: Cofinity Commercial |
$94.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.31
|
| Rate for Payer: Healthscope Commercial |
$99.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.83
|
| Rate for Payer: PHP Commercial |
$93.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.75
|
| Rate for Payer: Priority Health SBD |
$69.55
|
| Rate for Payer: UMR Bronson Commercial |
$40.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.79
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
NDC 68094005601
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$4.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 68094005658
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna Medicare |
$5.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.68
|
|
|
Service Code
|
NDC 68094005601
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
OP
|
$11.68
|
|
|
Service Code
|
NDC 68094005658
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna American Axle |
$7.59
|
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$8.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$10.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.93
|
| Rate for Payer: PHP Commercial |
$9.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.59
|
| Rate for Payer: Priority Health SBD |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$4.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.76
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRINGE (FOR ORAL USE ONLY)
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
189674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$10.01 |
| Rate for Payer: Aetna American Axle |
$7.23
|
| Rate for Payer: Aetna Commercial |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.23
|
| Rate for Payer: Cash Price |
$8.90
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Cofinity Commercial |
$9.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$10.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.45
|
| Rate for Payer: PHP Commercial |
$9.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.23
|
| Rate for Payer: Priority Health SBD |
$7.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.34
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$1,190.67
|
|
|
Service Code
|
NDC 00904656061
|
| Hospital Charge Code |
20919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.89 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Aetna American Axle |
$773.94
|
| Rate for Payer: Aetna Commercial |
$1,012.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.94
|
| Rate for Payer: Cash Price |
$952.54
|
| Rate for Payer: Cofinity Commercial |
$1,023.98
|
| Rate for Payer: Cofinity Commercial |
$833.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$833.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.54
|
| Rate for Payer: Healthscope Commercial |
$1,071.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$833.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.07
|
| Rate for Payer: PHP Commercial |
$1,012.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.94
|
| Rate for Payer: Priority Health SBD |
$750.12
|
| Rate for Payer: UMR Bronson Commercial |
$523.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.00
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$1,190.67
|
|
|
Service Code
|
NDC 00904656061
|
| Hospital Charge Code |
20919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.55 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Aetna American Axle |
$773.94
|
| Rate for Payer: Aetna Commercial |
$1,012.07
|
| Rate for Payer: Aetna Medicare |
$595.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.94
|
| Rate for Payer: BCBS Complete |
$476.27
|
| Rate for Payer: Cash Price |
$952.54
|
| Rate for Payer: Cofinity Commercial |
$1,023.98
|
| Rate for Payer: Cofinity Commercial |
$833.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$833.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$952.54
|
| Rate for Payer: Healthscope Commercial |
$1,071.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$833.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$893.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,012.07
|
| Rate for Payer: PHP Commercial |
$1,012.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.94
|
| Rate for Payer: Priority Health SBD |
$750.12
|
| Rate for Payer: UMR Bronson Commercial |
$440.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$893.00
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$341.23 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna American Axle |
$599.46
|
| Rate for Payer: Aetna Commercial |
$783.91
|
| Rate for Payer: Aetna Medicare |
$461.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.46
|
| Rate for Payer: BCBS Complete |
$368.90
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$645.58
|
| Rate for Payer: Cofinity Commercial |
$793.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Healthscope Commercial |
$830.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$645.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: PHP Commercial |
$783.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: Priority Health SBD |
$581.02
|
| Rate for Payer: UMR Bronson Commercial |
$341.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.69
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$431.90
|
|
|
Service Code
|
NDC 00406831501
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.80 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna American Axle |
$280.74
|
| Rate for Payer: Aetna Commercial |
$367.12
|
| Rate for Payer: Aetna Medicare |
$215.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.74
|
| Rate for Payer: BCBS Complete |
$172.76
|
| Rate for Payer: Cash Price |
$345.52
|
| Rate for Payer: Cofinity Commercial |
$302.33
|
| Rate for Payer: Cofinity Commercial |
$371.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.52
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.12
|
| Rate for Payer: PHP Commercial |
$367.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.74
|
| Rate for Payer: Priority Health SBD |
$272.10
|
| Rate for Payer: UMR Bronson Commercial |
$159.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.92
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.07 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Aetna American Axle |
$332.15
|
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna Medicare |
$255.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.15
|
| Rate for Payer: BCBS Complete |
$204.40
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.35
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: Priority Health SBD |
$321.93
|
| Rate for Payer: UMR Bronson Commercial |
$189.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
NDC 00406831562
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.84 |
| Max. Negotiated Rate |
$459.90 |
| Rate for Payer: Healthscope Commercial |
$459.90
|
| Rate for Payer: Aetna American Axle |
$332.15
|
| Rate for Payer: Aetna Commercial |
$434.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.15
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$357.70
|
| Rate for Payer: Cofinity Commercial |
$439.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$357.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.35
|
| Rate for Payer: PHP Commercial |
$434.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.15
|
| Rate for Payer: Priority Health SBD |
$321.93
|
| Rate for Payer: UMR Bronson Commercial |
$224.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.25
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna American Axle |
$364.00
|
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
| Rate for Payer: UMR Bronson Commercial |
$246.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Medicare |
$280.00
|
| Rate for Payer: Aetna American Axle |
$364.00
|
| Rate for Payer: Aetna Commercial |
$476.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.00
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$481.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.00
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.00
|
| Rate for Payer: PHP Commercial |
$476.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.00
|
| Rate for Payer: Priority Health SBD |
$352.80
|
| Rate for Payer: UMR Bronson Commercial |
$207.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.00
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$431.90
|
|
|
Service Code
|
NDC 00406831501
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.04 |
| Max. Negotiated Rate |
$388.71 |
| Rate for Payer: Aetna American Axle |
$280.74
|
| Rate for Payer: Aetna Commercial |
$367.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.74
|
| Rate for Payer: Cash Price |
$345.52
|
| Rate for Payer: Cofinity Commercial |
$302.33
|
| Rate for Payer: Cofinity Commercial |
$371.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.52
|
| Rate for Payer: Healthscope Commercial |
$388.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.12
|
| Rate for Payer: PHP Commercial |
$367.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.74
|
| Rate for Payer: Priority Health SBD |
$272.10
|
| Rate for Payer: UMR Bronson Commercial |
$190.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.92
|
|
|
MORPHINE ER 15 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$922.25
|
|
|
Service Code
|
NDC 00904655761
|
| Hospital Charge Code |
20920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.79 |
| Max. Negotiated Rate |
$830.02 |
| Rate for Payer: Aetna American Axle |
$599.46
|
| Rate for Payer: Aetna Commercial |
$783.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.46
|
| Rate for Payer: Cash Price |
$737.80
|
| Rate for Payer: Cofinity Commercial |
$645.58
|
| Rate for Payer: Cofinity Commercial |
$793.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$645.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$737.80
|
| Rate for Payer: Healthscope Commercial |
$830.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$645.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$691.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$783.91
|
| Rate for Payer: PHP Commercial |
$783.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.46
|
| Rate for Payer: Priority Health SBD |
$581.02
|
| Rate for Payer: UMR Bronson Commercial |
$405.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$691.69
|
|
|
MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE
|
Facility
|
IP
|
$1,662.57
|
|
|
Service Code
|
NDC 00228309011
|
| Hospital Charge Code |
32709
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$731.53 |
| Max. Negotiated Rate |
$1,496.31 |
| Rate for Payer: Aetna American Axle |
$1,080.67
|
| Rate for Payer: Aetna Commercial |
$1,413.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.67
|
| Rate for Payer: Cash Price |
$1,330.06
|
| Rate for Payer: Cofinity Commercial |
$1,163.80
|
| Rate for Payer: Cofinity Commercial |
$1,429.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,163.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,330.06
|
| Rate for Payer: Healthscope Commercial |
$1,496.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,163.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,246.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.18
|
| Rate for Payer: PHP Commercial |
$1,413.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.67
|
| Rate for Payer: Priority Health SBD |
$1,047.42
|
| Rate for Payer: UMR Bronson Commercial |
$731.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,246.93
|
|
|
MORPHINE ER 30 MG CAPSULE,EXTENDED RELEASE 24 HR MULTIPHASE
|
Facility
|
OP
|
$1,662.57
|
|
|
Service Code
|
NDC 00228309011
|
| Hospital Charge Code |
32709
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$615.15 |
| Max. Negotiated Rate |
$1,496.31 |
| Rate for Payer: Aetna American Axle |
$1,080.67
|
| Rate for Payer: Aetna Commercial |
$1,413.18
|
| Rate for Payer: Aetna Medicare |
$831.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,080.67
|
| Rate for Payer: BCBS Complete |
$665.03
|
| Rate for Payer: Cash Price |
$1,330.06
|
| Rate for Payer: Cofinity Commercial |
$1,163.80
|
| Rate for Payer: Cofinity Commercial |
$1,429.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,163.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,330.06
|
| Rate for Payer: Healthscope Commercial |
$1,496.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,163.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,246.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,413.18
|
| Rate for Payer: PHP Commercial |
$1,413.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.67
|
| Rate for Payer: Priority Health SBD |
$1,047.42
|
| Rate for Payer: UMR Bronson Commercial |
$615.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,246.93
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$7.89
|
|
|
Service Code
|
NDC 00406833023
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.10 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
MORPHINE ER 30 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$708.75 |
| Rate for Payer: Aetna American Axle |
$511.88
|
| Rate for Payer: Aetna Commercial |
$669.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.88
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cofinity Commercial |
$551.25
|
| Rate for Payer: Cofinity Commercial |
$677.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$551.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$630.00
|
| Rate for Payer: Healthscope Commercial |
$708.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$551.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$669.38
|
| Rate for Payer: PHP Commercial |
$669.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.88
|
| Rate for Payer: Priority Health SBD |
$496.12
|
| Rate for Payer: UMR Bronson Commercial |
$346.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.62
|
|
