Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

MINOR SKIN DISORDERS WITH MCC

Facility

$20,361.67

Service Code	MS-DRG 606
Min. Negotiated Rate	$14,351.60
Max. Negotiated Rate	$20,361.67
Rate for Payer: Aetna Medicare	$15,106.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,883.69
Rate for Payer: Amish Plain Church Group Commercial	$18,883.69
Rate for Payer: BCBS MAPPO	$15,106.95
Rate for Payer: BCN Medicare Advantage	$15,106.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,106.95
Rate for Payer: Humana Choice PPO Medicare	$15,106.95
Rate for Payer: Mclaren Medicare	$15,106.95
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,862.30
Rate for Payer: MI Amish Medical Board Commercial	$17,372.99
Rate for Payer: PACE Medicare	$14,351.60
Rate for Payer: PACE SWMI	$15,106.95
Rate for Payer: PHP Commercial	$16,617.64
Rate for Payer: PHP Medicare Advantage	$15,106.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,361.67
Rate for Payer: Priority Health Medicare	$15,106.95
Rate for Payer: Priority Health Narrow Network	$16,289.34
Rate for Payer: Railroad Medicare Medicare	$15,106.95
Rate for Payer: UHC Medicare Advantage	$15,560.16
Rate for Payer: VA VA	$15,106.95

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$11,557.08

Service Code	MS-DRG 607
Min. Negotiated Rate	$8,783.38
Max. Negotiated Rate	$11,557.08
Rate for Payer: Aetna Medicare	$9,245.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,557.08
Rate for Payer: Amish Plain Church Group Commercial	$11,557.08
Rate for Payer: BCBS MAPPO	$9,245.66
Rate for Payer: BCN Medicare Advantage	$9,245.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,245.66
Rate for Payer: Humana Choice PPO Medicare	$9,245.66
Rate for Payer: Mclaren Medicare	$9,245.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,707.94
Rate for Payer: MI Amish Medical Board Commercial	$10,632.51
Rate for Payer: PACE Medicare	$8,783.38
Rate for Payer: PACE SWMI	$9,245.66
Rate for Payer: PHP Commercial	$10,170.23
Rate for Payer: PHP Medicare Advantage	$9,245.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,472.54
Rate for Payer: Priority Health Medicare	$9,245.66
Rate for Payer: Priority Health Narrow Network	$9,178.03
Rate for Payer: Railroad Medicare Medicare	$9,245.66
Rate for Payer: UHC Medicare Advantage	$9,523.03
Rate for Payer: VA VA	$9,245.66

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$19,781.30

Service Code	MS-DRG 345
Min. Negotiated Rate	$13,988.05
Max. Negotiated Rate	$19,781.30
Rate for Payer: Aetna Medicare	$14,724.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,405.32
Rate for Payer: Amish Plain Church Group Commercial	$18,405.32
Rate for Payer: BCBS MAPPO	$14,724.26
Rate for Payer: BCN Medicare Advantage	$14,724.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,724.26
Rate for Payer: Humana Choice PPO Medicare	$14,724.26
Rate for Payer: Mclaren Medicare	$14,724.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,460.47
Rate for Payer: MI Amish Medical Board Commercial	$16,932.90
Rate for Payer: PACE Medicare	$13,988.05
Rate for Payer: PACE SWMI	$14,724.26
Rate for Payer: PHP Commercial	$16,196.69
Rate for Payer: PHP Medicare Advantage	$14,724.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,781.30
Rate for Payer: Priority Health Medicare	$14,724.26
Rate for Payer: Priority Health Narrow Network	$15,825.04
Rate for Payer: Railroad Medicare Medicare	$14,724.26
Rate for Payer: UHC Medicare Advantage	$15,165.99
Rate for Payer: VA VA	$14,724.26

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$35,186.74

Service Code	MS-DRG 344
Min. Negotiated Rate	$23,638.14
Max. Negotiated Rate	$35,186.74
Rate for Payer: Aetna Medicare	$24,882.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$31,102.81
Rate for Payer: Amish Plain Church Group Commercial	$31,102.81
Rate for Payer: BCBS MAPPO	$24,882.25
Rate for Payer: BCN Medicare Advantage	$24,882.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$24,882.25
Rate for Payer: Humana Choice PPO Medicare	$24,882.25
Rate for Payer: Mclaren Medicare	$24,882.25
Rate for Payer: Meridian Wellcare - Medicare Advantage	$26,126.36
Rate for Payer: MI Amish Medical Board Commercial	$28,614.59
Rate for Payer: PACE Medicare	$23,638.14
Rate for Payer: PACE SWMI	$24,882.25
Rate for Payer: PHP Commercial	$27,370.48
Rate for Payer: PHP Medicare Advantage	$24,882.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35,186.74
Rate for Payer: Priority Health Medicare	$24,882.25
Rate for Payer: Priority Health Narrow Network	$28,149.39
Rate for Payer: Railroad Medicare Medicare	$24,882.25
Rate for Payer: UHC Medicare Advantage	$25,628.72
Rate for Payer: VA VA	$24,882.25

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$16,535.35

Service Code	MS-DRG 346
Min. Negotiated Rate	$11,954.76
Max. Negotiated Rate	$16,535.35
Rate for Payer: Aetna Medicare	$12,583.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,729.95
Rate for Payer: Amish Plain Church Group Commercial	$15,729.95
Rate for Payer: BCBS MAPPO	$12,583.96
Rate for Payer: BCN Medicare Advantage	$12,583.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,583.96
Rate for Payer: Humana Choice PPO Medicare	$12,583.96
Rate for Payer: Mclaren Medicare	$12,583.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13,213.16
Rate for Payer: MI Amish Medical Board Commercial	$14,471.55
Rate for Payer: PACE Medicare	$11,954.76
Rate for Payer: PACE SWMI	$12,583.96
Rate for Payer: PHP Commercial	$13,842.36
Rate for Payer: PHP Medicare Advantage	$12,583.96
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,535.35
Rate for Payer: Priority Health Medicare	$12,583.96
Rate for Payer: Priority Health Narrow Network	$13,228.28
Rate for Payer: Railroad Medicare Medicare	$12,583.96
Rate for Payer: UHC Medicare Advantage	$12,961.48
Rate for Payer: VA VA	$12,583.96

MINOXIDIL 10 MG TABLET

Facility

$2.62

Service Code	NDC 68084-205-11
Hospital Charge Code	5114
Hospital Revenue Code	637
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.62
Rate for Payer: Aetna Commercial	$2.36
Rate for Payer: ASR ASR	$2.54
Rate for Payer: BCBS Trust/PPO	$2.03
Rate for Payer: BCN Commercial	$2.03
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cofinity Commercial	$2.46
Rate for Payer: Encore Health Key Benefits Commercial	$2.10
Rate for Payer: Healthscope Commercial	$2.62
Rate for Payer: Healthscope Whirlpool	$2.54
Rate for Payer: Mclaren Commercial	$2.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.23
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.31

MINOXIDIL 10 MG TABLET

Facility

$401.85

Service Code	NDC 49884-257-01
Hospital Charge Code	5114
Hospital Revenue Code	637
Min. Negotiated Rate	$281.30
Max. Negotiated Rate	$401.85
Rate for Payer: Aetna Commercial	$361.66
Rate for Payer: ASR ASR	$389.79
Rate for Payer: BCBS Trust/PPO	$311.55
Rate for Payer: BCN Commercial	$311.55
Rate for Payer: Cash Price	$321.48
Rate for Payer: Cofinity Commercial	$377.74
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$401.85
Rate for Payer: Healthscope Whirlpool	$389.79
Rate for Payer: Mclaren Commercial	$361.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$341.57
Rate for Payer: Priority Health Cigna Priority Health	$281.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$353.63

MINOXIDIL 10 MG TABLET

Facility

$410.40

Service Code	NDC 0591-5643-01
Hospital Charge Code	5114
Hospital Revenue Code	637
Min. Negotiated Rate	$287.28
Max. Negotiated Rate	$410.40
Rate for Payer: Aetna Commercial	$369.36
Rate for Payer: ASR ASR	$398.09
Rate for Payer: BCBS Trust/PPO	$318.18
Rate for Payer: BCN Commercial	$318.18
Rate for Payer: Cash Price	$328.32
Rate for Payer: Cofinity Commercial	$385.78
Rate for Payer: Encore Health Key Benefits Commercial	$328.32
Rate for Payer: Healthscope Commercial	$410.40
Rate for Payer: Healthscope Whirlpool	$398.09
Rate for Payer: Mclaren Commercial	$369.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$348.84
Rate for Payer: Priority Health Cigna Priority Health	$287.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$361.15

MINOXIDIL 10 MG TABLET

Facility

$262.08

Service Code	NDC 68084-205-01
Hospital Charge Code	5114
Hospital Revenue Code	637
Min. Negotiated Rate	$183.46
Max. Negotiated Rate	$262.08
Rate for Payer: Aetna Commercial	$235.87
Rate for Payer: ASR ASR	$254.22
Rate for Payer: BCBS Trust/PPO	$203.19
Rate for Payer: BCN Commercial	$203.19
Rate for Payer: Cash Price	$209.66
Rate for Payer: Cofinity Commercial	$246.36
Rate for Payer: Encore Health Key Benefits Commercial	$209.66
Rate for Payer: Healthscope Commercial	$262.08
Rate for Payer: Healthscope Whirlpool	$254.22
Rate for Payer: Mclaren Commercial	$235.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$222.77
Rate for Payer: Priority Health Cigna Priority Health	$183.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$230.63

MIRTAZAPINE 15 MG TABLET

Facility

$279.65

Service Code	NDC 0904-6519-61
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$195.76
Max. Negotiated Rate	$279.65
Rate for Payer: Aetna Commercial	$251.68
Rate for Payer: ASR ASR	$271.26
Rate for Payer: BCBS Trust/PPO	$216.81
Rate for Payer: BCN Commercial	$216.81
Rate for Payer: Cash Price	$223.72
Rate for Payer: Cofinity Commercial	$262.87
Rate for Payer: Encore Health Key Benefits Commercial	$223.72
Rate for Payer: Healthscope Commercial	$279.65
Rate for Payer: Healthscope Whirlpool	$271.26
Rate for Payer: Mclaren Commercial	$251.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$237.70
Rate for Payer: Priority Health Cigna Priority Health	$195.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$246.09

MIRTAZAPINE 15 MG TABLET

Facility

$3.50

Service Code	NDC 51079-086-01
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$3.50
Rate for Payer: Aetna Commercial	$3.15
Rate for Payer: ASR ASR	$3.40
Rate for Payer: BCBS Trust/PPO	$2.71
Rate for Payer: BCN Commercial	$2.71
Rate for Payer: Cash Price	$2.80
Rate for Payer: Cofinity Commercial	$3.29
Rate for Payer: Encore Health Key Benefits Commercial	$2.80
Rate for Payer: Healthscope Commercial	$3.50
Rate for Payer: Healthscope Whirlpool	$3.40
Rate for Payer: Mclaren Commercial	$3.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.98
Rate for Payer: Priority Health Cigna Priority Health	$2.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.08

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$16,887.17

Service Code	MS-DRG 640
Min. Negotiated Rate	$12,175.14
Max. Negotiated Rate	$16,887.17
Rate for Payer: Aetna Medicare	$12,815.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,019.92
Rate for Payer: Amish Plain Church Group Commercial	$16,019.92
Rate for Payer: BCBS MAPPO	$12,815.94
Rate for Payer: BCN Medicare Advantage	$12,815.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,815.94
Rate for Payer: Humana Choice PPO Medicare	$12,815.94
Rate for Payer: Mclaren Medicare	$12,815.94
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13,456.74
Rate for Payer: MI Amish Medical Board Commercial	$14,738.33
Rate for Payer: PACE Medicare	$12,175.14
Rate for Payer: PACE SWMI	$12,815.94
Rate for Payer: PHP Commercial	$14,097.53
Rate for Payer: PHP Medicare Advantage	$12,815.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16,887.17
Rate for Payer: Priority Health Medicare	$12,815.94
Rate for Payer: Priority Health Narrow Network	$13,509.74
Rate for Payer: Railroad Medicare Medicare	$12,815.94
Rate for Payer: UHC Medicare Advantage	$13,200.42
Rate for Payer: VA VA	$12,815.94

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$10,370.72

Service Code	MS-DRG 641
Min. Negotiated Rate	$7,881.75
Max. Negotiated Rate	$10,370.72
Rate for Payer: Aetna Medicare	$8,296.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,370.72
Rate for Payer: Amish Plain Church Group Commercial	$10,370.72
Rate for Payer: BCBS MAPPO	$8,296.58
Rate for Payer: BCN Medicare Advantage	$8,296.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,296.58
Rate for Payer: Humana Choice PPO Medicare	$8,296.58
Rate for Payer: Mclaren Medicare	$8,296.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,711.41
Rate for Payer: MI Amish Medical Board Commercial	$9,541.07
Rate for Payer: PACE Medicare	$7,881.75
Rate for Payer: PACE SWMI	$8,296.58
Rate for Payer: PHP Commercial	$9,126.24
Rate for Payer: PHP Medicare Advantage	$8,296.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,033.18
Rate for Payer: Priority Health Medicare	$8,296.58
Rate for Payer: Priority Health Narrow Network	$8,026.54
Rate for Payer: Railroad Medicare Medicare	$8,296.58
Rate for Payer: UHC Medicare Advantage	$8,545.48
Rate for Payer: VA VA	$8,296.58

MISOPROSTOL 200 MCG TABLET

Facility

$258.62

Service Code	NDC 59762-5008-1
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$181.03
Max. Negotiated Rate	$258.62
Rate for Payer: Aetna Commercial	$232.76
Rate for Payer: ASR ASR	$250.86
Rate for Payer: BCBS Trust/PPO	$200.51
Rate for Payer: BCN Commercial	$200.51
Rate for Payer: Cash Price	$206.90
Rate for Payer: Cofinity Commercial	$243.10
Rate for Payer: Encore Health Key Benefits Commercial	$206.90
Rate for Payer: Healthscope Commercial	$258.62
Rate for Payer: Healthscope Whirlpool	$250.86
Rate for Payer: Mclaren Commercial	$232.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.83
Rate for Payer: Priority Health Cigna Priority Health	$181.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$227.59

MISOPROSTOL 200 MCG TABLET

Facility

$258.62

Service Code	NDC 43386-161-06
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$181.03
Max. Negotiated Rate	$258.62
Rate for Payer: Aetna Commercial	$232.76
Rate for Payer: ASR ASR	$250.86
Rate for Payer: BCBS Trust/PPO	$200.51
Rate for Payer: BCN Commercial	$200.51
Rate for Payer: Cash Price	$206.90
Rate for Payer: Cofinity Commercial	$243.10
Rate for Payer: Encore Health Key Benefits Commercial	$206.90
Rate for Payer: Healthscope Commercial	$258.62
Rate for Payer: Healthscope Whirlpool	$250.86
Rate for Payer: Mclaren Commercial	$232.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.83
Rate for Payer: Priority Health Cigna Priority Health	$181.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$227.59

MISOPROSTOL 200 MCG TABLET

Facility

$207.65

Service Code	NDC 70954-444-10
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$145.36
Max. Negotiated Rate	$207.65
Rate for Payer: Aetna Commercial	$186.88
Rate for Payer: ASR ASR	$201.42
Rate for Payer: BCBS Trust/PPO	$160.99
Rate for Payer: BCN Commercial	$160.99
Rate for Payer: Cash Price	$166.12
Rate for Payer: Cofinity Commercial	$195.19
Rate for Payer: Encore Health Key Benefits Commercial	$166.12
Rate for Payer: Healthscope Commercial	$207.65
Rate for Payer: Healthscope Whirlpool	$201.42
Rate for Payer: Mclaren Commercial	$186.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$176.50
Rate for Payer: Priority Health Cigna Priority Health	$145.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$182.73

MISOPROSTOL 200 MCG TABLET

Facility

$431.04

Service Code	NDC 59762-5008-2
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$301.73
Max. Negotiated Rate	$431.04
Rate for Payer: Aetna Commercial	$387.94
Rate for Payer: ASR ASR	$418.11
Rate for Payer: BCBS Trust/PPO	$334.19
Rate for Payer: BCN Commercial	$334.19
Rate for Payer: Cash Price	$344.83
Rate for Payer: Cofinity Commercial	$405.18
Rate for Payer: Encore Health Key Benefits Commercial	$344.83
Rate for Payer: Healthscope Commercial	$431.04
Rate for Payer: Healthscope Whirlpool	$418.11
Rate for Payer: Mclaren Commercial	$387.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$366.38
Rate for Payer: Priority Health Cigna Priority Health	$301.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$379.32

MOLASSES

Facility

$23.94

Service Code	NDC 0990-0000-75
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$16.76
Max. Negotiated Rate	$23.94
Rate for Payer: Aetna Commercial	$21.55
Rate for Payer: ASR ASR	$23.22
Rate for Payer: BCBS Trust/PPO	$18.56
Rate for Payer: BCN Commercial	$18.56
Rate for Payer: Cash Price	$19.15
Rate for Payer: Cofinity Commercial	$22.50
Rate for Payer: Encore Health Key Benefits Commercial	$19.15
Rate for Payer: Healthscope Commercial	$23.94
Rate for Payer: Healthscope Whirlpool	$23.22
Rate for Payer: Mclaren Commercial	$21.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.35
Rate for Payer: Priority Health Cigna Priority Health	$16.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.07

MONALISA TOUCH, SERIES, UP TO 3 VISITS

Professional

Both

$1,800.00

Service Code	HCPCS 00561
Hospital Revenue Code	990
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,260.00
Rate for Payer: BCBS Complete	$720.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Priority Health Cigna Priority Health	$1,260.00

MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES

Professional

Both

$600.00

Service Code	HCPCS 00562
Hospital Revenue Code	990
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

MONTELUKAST 10 MG TABLET

Facility

$236.55

Service Code	NDC 0904-6808-61
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$165.58
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$212.90
Rate for Payer: ASR ASR	$229.45
Rate for Payer: BCBS Trust/PPO	$183.40
Rate for Payer: BCN Commercial	$183.40
Rate for Payer: Cash Price	$189.24
Rate for Payer: Cofinity Commercial	$222.36
Rate for Payer: Encore Health Key Benefits Commercial	$189.24
Rate for Payer: Healthscope Commercial	$236.55
Rate for Payer: Healthscope Whirlpool	$229.45
Rate for Payer: Mclaren Commercial	$212.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.07
Rate for Payer: Priority Health Cigna Priority Health	$165.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$208.16

MORPHINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$17.18

Service Code	HCPCS J2270
Hospital Charge Code	27390
Hospital Revenue Code	636
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$17.18
Rate for Payer: Aetna Commercial	$15.46
Rate for Payer: ASR ASR	$16.66
Rate for Payer: BCBS Trust/PPO	$13.32
Rate for Payer: BCN Commercial	$13.32
Rate for Payer: Cash Price	$13.75
Rate for Payer: Cofinity Commercial	$16.15
Rate for Payer: Encore Health Key Benefits Commercial	$13.74
Rate for Payer: Healthscope Commercial	$17.18
Rate for Payer: Healthscope Whirlpool	$16.66
Rate for Payer: Mclaren Commercial	$15.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.60
Rate for Payer: Priority Health Cigna Priority Health	$12.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.12

MORPHINE 10 MG/ML SYRINGE (CODE)

Facility

$16.25

Service Code	HCPCS J2270
Hospital Charge Code	163726
Hospital Revenue Code	636
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$16.25
Rate for Payer: Aetna Commercial	$14.62
Rate for Payer: ASR ASR	$15.76
Rate for Payer: BCBS Trust/PPO	$12.60
Rate for Payer: BCN Commercial	$12.60
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cofinity Commercial	$15.28
Rate for Payer: Encore Health Key Benefits Commercial	$13.00
Rate for Payer: Healthscope Commercial	$16.25
Rate for Payer: Healthscope Whirlpool	$15.76
Rate for Payer: Mclaren Commercial	$14.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.81
Rate for Payer: Priority Health Cigna Priority Health	$11.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.30

MORPHINE 15 MG IMMEDIATE RELEASE TABLET

Facility

$123.38

Service Code	NDC 0054-0235-24
Hospital Charge Code	5178
Hospital Revenue Code	637
Min. Negotiated Rate	$86.37
Max. Negotiated Rate	$123.38
Rate for Payer: Aetna Commercial	$111.04
Rate for Payer: ASR ASR	$119.68
Rate for Payer: BCBS Trust/PPO	$95.66
Rate for Payer: BCN Commercial	$95.66
Rate for Payer: Cash Price	$98.70
Rate for Payer: Cofinity Commercial	$115.98
Rate for Payer: Encore Health Key Benefits Commercial	$98.70
Rate for Payer: Healthscope Commercial	$123.38
Rate for Payer: Healthscope Whirlpool	$119.68
Rate for Payer: Mclaren Commercial	$111.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$104.87
Rate for Payer: Priority Health Cigna Priority Health	$86.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$108.57

MORPHINE 2 MG/ML INJECTION SYRINGE

Facility

$24.77

Service Code	HCPCS J2270
Hospital Charge Code	5170
Hospital Revenue Code	636
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$24.77
Rate for Payer: Aetna Commercial	$22.29
Rate for Payer: ASR ASR	$24.03
Rate for Payer: BCBS Trust/PPO	$19.20
Rate for Payer: BCN Commercial	$19.20
Rate for Payer: Cash Price	$19.82
Rate for Payer: Cofinity Commercial	$23.28
Rate for Payer: Encore Health Key Benefits Commercial	$19.82
Rate for Payer: Healthscope Commercial	$24.77
Rate for Payer: Healthscope Whirlpool	$24.03
Rate for Payer: Mclaren Commercial	$22.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.05
Rate for Payer: Priority Health Cigna Priority Health	$17.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.80

Know your out-of-pocket cost for care.

All Charges