|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$476.55
|
|
|
Service Code
|
NDC 00574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.76 |
| Max. Negotiated Rate |
$476.55 |
| Rate for Payer: Aetna Commercial |
$428.90
|
| Rate for Payer: ASR ASR |
$462.25
|
| Rate for Payer: ASR Commercial |
$462.25
|
| Rate for Payer: BCBS Trust/PPO |
$388.34
|
| Rate for Payer: BCN Commercial |
$369.47
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$447.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$476.55
|
| Rate for Payer: Healthscope Whirlpool |
$462.25
|
| Rate for Payer: Mclaren Commercial |
$428.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.36
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$89.17
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$89.17 |
| Rate for Payer: Aetna Commercial |
$80.25
|
| Rate for Payer: ASR ASR |
$86.49
|
| Rate for Payer: ASR Commercial |
$86.49
|
| Rate for Payer: BCBS Trust/PPO |
$72.66
|
| Rate for Payer: BCN Commercial |
$69.13
|
| Rate for Payer: Cash Price |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$83.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.34
|
| Rate for Payer: Healthscope Commercial |
$89.17
|
| Rate for Payer: Healthscope Whirlpool |
$86.49
|
| Rate for Payer: Mclaren Commercial |
$80.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.79
|
| Rate for Payer: Nomi Health Commercial |
$73.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.47
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$474.81
|
|
|
Service Code
|
NDC 00713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.92 |
| Max. Negotiated Rate |
$474.81 |
| Rate for Payer: Aetna Commercial |
$427.33
|
| Rate for Payer: Aetna Medicare |
$237.40
|
| Rate for Payer: ASR ASR |
$460.57
|
| Rate for Payer: ASR Commercial |
$460.57
|
| Rate for Payer: BCBS Complete |
$189.92
|
| Rate for Payer: BCBS Trust/PPO |
$388.82
|
| Rate for Payer: BCN Commercial |
$368.12
|
| Rate for Payer: Cash Price |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$446.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.85
|
| Rate for Payer: Healthscope Commercial |
$474.81
|
| Rate for Payer: Healthscope Whirlpool |
$460.57
|
| Rate for Payer: Mclaren Commercial |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.59
|
| Rate for Payer: Nomi Health Commercial |
$389.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.03
|
| Rate for Payer: Priority Health Narrow Network |
$332.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.83
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$89.17
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$89.17 |
| Rate for Payer: Aetna Commercial |
$80.25
|
| Rate for Payer: Aetna Medicare |
$44.58
|
| Rate for Payer: ASR ASR |
$86.49
|
| Rate for Payer: ASR Commercial |
$86.49
|
| Rate for Payer: BCBS Complete |
$35.67
|
| Rate for Payer: BCBS Trust/PPO |
$73.02
|
| Rate for Payer: BCN Commercial |
$69.13
|
| Rate for Payer: Cash Price |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$83.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.34
|
| Rate for Payer: Healthscope Commercial |
$89.17
|
| Rate for Payer: Healthscope Whirlpool |
$86.49
|
| Rate for Payer: Mclaren Commercial |
$80.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.79
|
| Rate for Payer: Nomi Health Commercial |
$73.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.13
|
| Rate for Payer: Priority Health Narrow Network |
$62.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.47
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
NDC 00713050306
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.83 |
| Max. Negotiated Rate |
$39.57 |
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: Aetna Medicare |
$19.78
|
| Rate for Payer: ASR ASR |
$38.38
|
| Rate for Payer: ASR Commercial |
$38.38
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$32.40
|
| Rate for Payer: BCN Commercial |
$30.68
|
| Rate for Payer: Cash Price |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$39.57
|
| Rate for Payer: Healthscope Whirlpool |
$38.38
|
| Rate for Payer: Mclaren Commercial |
$35.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: Nomi Health Commercial |
$32.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.67
|
| Rate for Payer: Priority Health Narrow Network |
$27.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.82
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: ASR ASR |
$7.21
|
| Rate for Payer: ASR Commercial |
$7.21
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.08
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.94
|
| Rate for Payer: Healthscope Commercial |
$7.43
|
| Rate for Payer: Healthscope Whirlpool |
$7.21
|
| Rate for Payer: Mclaren Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.51
|
| Rate for Payer: Priority Health Narrow Network |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.54
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: ASR Commercial |
$7.66
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.47
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.90
|
| Rate for Payer: Healthscope Whirlpool |
$7.66
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.92
|
| Rate for Payer: Priority Health Narrow Network |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: ASR Commercial |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.90
|
| Rate for Payer: Healthscope Whirlpool |
$7.66
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 00536127780
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.14 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: ASR Commercial |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.90
|
| Rate for Payer: Healthscope Whirlpool |
$7.66
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 00536127780
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: ASR Commercial |
$7.66
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.47
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.90
|
| Rate for Payer: Healthscope Whirlpool |
$7.66
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.92
|
| Rate for Payer: Priority Health Narrow Network |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$78.05
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$70.24
|
| Rate for Payer: Aetna Medicare |
$39.02
|
| Rate for Payer: ASR ASR |
$75.71
|
| Rate for Payer: ASR Commercial |
$75.71
|
| Rate for Payer: BCBS Complete |
$31.22
|
| Rate for Payer: BCBS Trust/PPO |
$63.92
|
| Rate for Payer: BCN Commercial |
$60.51
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.44
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Healthscope Whirlpool |
$75.71
|
| Rate for Payer: Mclaren Commercial |
$70.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.34
|
| Rate for Payer: Nomi Health Commercial |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.36
|
| Rate for Payer: Priority Health Narrow Network |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.68
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$78.05
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$70.24
|
| Rate for Payer: ASR ASR |
$75.71
|
| Rate for Payer: ASR Commercial |
$75.71
|
| Rate for Payer: BCBS Trust/PPO |
$63.60
|
| Rate for Payer: BCN Commercial |
$60.51
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.44
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Healthscope Whirlpool |
$75.71
|
| Rate for Payer: Mclaren Commercial |
$70.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.34
|
| Rate for Payer: Nomi Health Commercial |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.68
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$575.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$374.02 |
| Max. Negotiated Rate |
$575.42 |
| Rate for Payer: Aetna Commercial |
$517.88
|
| Rate for Payer: ASR ASR |
$558.16
|
| Rate for Payer: ASR Commercial |
$558.16
|
| Rate for Payer: BCBS Trust/PPO |
$468.91
|
| Rate for Payer: BCN Commercial |
$446.12
|
| Rate for Payer: Cash Price |
$460.34
|
| Rate for Payer: Cofinity Commercial |
$540.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.34
|
| Rate for Payer: Healthscope Commercial |
$575.42
|
| Rate for Payer: Healthscope Whirlpool |
$558.16
|
| Rate for Payer: Mclaren Commercial |
$517.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.11
|
| Rate for Payer: Nomi Health Commercial |
$471.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.37
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$575.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$575.42 |
| Rate for Payer: Aetna Commercial |
$517.88
|
| Rate for Payer: Aetna Medicare |
$287.71
|
| Rate for Payer: ASR ASR |
$558.16
|
| Rate for Payer: ASR Commercial |
$558.16
|
| Rate for Payer: BCBS Complete |
$230.17
|
| Rate for Payer: BCBS Trust/PPO |
$471.21
|
| Rate for Payer: BCN Commercial |
$446.12
|
| Rate for Payer: Cash Price |
$460.34
|
| Rate for Payer: Cash Price |
$460.34
|
| Rate for Payer: Cofinity Commercial |
$540.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.34
|
| Rate for Payer: Healthscope Commercial |
$575.42
|
| Rate for Payer: Healthscope Whirlpool |
$558.16
|
| Rate for Payer: Mclaren Commercial |
$517.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.11
|
| Rate for Payer: Nomi Health Commercial |
$471.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.36
|
| Rate for Payer: Priority Health Narrow Network |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.37
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$97.58 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: Aetna Medicare |
$48.79
|
| Rate for Payer: ASR ASR |
$94.65
|
| Rate for Payer: ASR Commercial |
$94.65
|
| Rate for Payer: BCBS Complete |
$39.03
|
| Rate for Payer: BCBS Trust/PPO |
$79.91
|
| Rate for Payer: BCN Commercial |
$75.65
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$91.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$97.58
|
| Rate for Payer: Healthscope Whirlpool |
$94.65
|
| Rate for Payer: Mclaren Commercial |
$87.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$80.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.36
|
| Rate for Payer: Priority Health Narrow Network |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.87
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$97.58 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: ASR ASR |
$94.65
|
| Rate for Payer: ASR Commercial |
$94.65
|
| Rate for Payer: BCBS Trust/PPO |
$79.52
|
| Rate for Payer: BCN Commercial |
$75.65
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$91.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$97.58
|
| Rate for Payer: Healthscope Whirlpool |
$94.65
|
| Rate for Payer: Mclaren Commercial |
$87.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$80.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.87
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$182.94
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$182.94 |
| Rate for Payer: Aetna Commercial |
$164.65
|
| Rate for Payer: ASR ASR |
$177.45
|
| Rate for Payer: ASR Commercial |
$177.45
|
| Rate for Payer: BCBS Trust/PPO |
$149.08
|
| Rate for Payer: BCN Commercial |
$141.83
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$171.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.35
|
| Rate for Payer: Healthscope Commercial |
$182.94
|
| Rate for Payer: Healthscope Whirlpool |
$177.45
|
| Rate for Payer: Mclaren Commercial |
$164.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.50
|
| Rate for Payer: Nomi Health Commercial |
$150.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.99
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$182.94
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$182.94 |
| Rate for Payer: Aetna Commercial |
$164.65
|
| Rate for Payer: Aetna Medicare |
$91.47
|
| Rate for Payer: ASR ASR |
$177.45
|
| Rate for Payer: ASR Commercial |
$177.45
|
| Rate for Payer: BCBS Complete |
$73.18
|
| Rate for Payer: BCBS Trust/PPO |
$149.81
|
| Rate for Payer: BCN Commercial |
$141.83
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$171.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.35
|
| Rate for Payer: Healthscope Commercial |
$182.94
|
| Rate for Payer: Healthscope Whirlpool |
$177.45
|
| Rate for Payer: Mclaren Commercial |
$164.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.50
|
| Rate for Payer: Nomi Health Commercial |
$150.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.36
|
| Rate for Payer: Priority Health Narrow Network |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.99
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: ASR ASR |
$15.15
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: ASR Commercial |
$15.98
|
| Rate for Payer: ASR Commercial |
$15.15
|
| Rate for Payer: ASR Commercial |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$12.11
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Healthscope Whirlpool |
$15.98
|
| Rate for Payer: Healthscope Whirlpool |
$15.15
|
| Rate for Payer: Healthscope Whirlpool |
$20.83
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: Mclaren Commercial |
$14.06
|
| Rate for Payer: Mclaren Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.28
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: ASR ASR |
$15.15
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: ASR Commercial |
$15.98
|
| Rate for Payer: ASR Commercial |
$15.15
|
| Rate for Payer: ASR Commercial |
$20.83
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: BCN Commercial |
$12.11
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Healthscope Whirlpool |
$15.98
|
| Rate for Payer: Healthscope Whirlpool |
$20.83
|
| Rate for Payer: Healthscope Whirlpool |
$15.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Mclaren Commercial |
$14.06
|
| Rate for Payer: Mclaren Commercial |
$19.32
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$21.93
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$21.93 |
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Aetna Commercial |
$28.77
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: ASR ASR |
$21.27
|
| Rate for Payer: ASR ASR |
$16.61
|
| Rate for Payer: ASR ASR |
$31.01
|
| Rate for Payer: ASR Commercial |
$21.27
|
| Rate for Payer: ASR Commercial |
$16.61
|
| Rate for Payer: ASR Commercial |
$31.01
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Commercial |
$13.27
|
| Rate for Payer: BCN Commercial |
$24.79
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$31.97
|
| Rate for Payer: Healthscope Whirlpool |
$21.27
|
| Rate for Payer: Healthscope Whirlpool |
$31.01
|
| Rate for Payer: Healthscope Whirlpool |
$16.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Mclaren Commercial |
$15.41
|
| Rate for Payer: Mclaren Commercial |
$28.77
|
| Rate for Payer: Mclaren Commercial |
$19.74
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$17.98
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
| Rate for Payer: VA VA |
$0.09
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$21.93
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$21.93 |
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Aetna Commercial |
$28.77
|
| Rate for Payer: ASR ASR |
$31.01
|
| Rate for Payer: ASR ASR |
$21.27
|
| Rate for Payer: ASR ASR |
$16.61
|
| Rate for Payer: ASR Commercial |
$16.61
|
| Rate for Payer: ASR Commercial |
$31.01
|
| Rate for Payer: ASR Commercial |
$21.27
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$26.05
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCN Commercial |
$24.79
|
| Rate for Payer: BCN Commercial |
$13.27
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Healthscope Commercial |
$31.97
|
| Rate for Payer: Healthscope Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Whirlpool |
$31.01
|
| Rate for Payer: Healthscope Whirlpool |
$21.27
|
| Rate for Payer: Healthscope Whirlpool |
$16.61
|
| Rate for Payer: Mclaren Commercial |
$15.41
|
| Rate for Payer: Mclaren Commercial |
$28.77
|
| Rate for Payer: Mclaren Commercial |
$19.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$17.98
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.13
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: ASR ASR |
$13.65
|
| Rate for Payer: ASR Commercial |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Healthscope Whirlpool |
$13.65
|
| Rate for Payer: Mclaren Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.38
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.11
|
| Rate for Payer: ASR ASR |
$13.65
|
| Rate for Payer: ASR Commercial |
$13.65
|
| Rate for Payer: BCBS Complete |
$0.05
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Healthscope Whirlpool |
$13.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.09
|
| Rate for Payer: Mclaren Commercial |
$12.66
|
| Rate for Payer: Mclaren Medicaid |
$0.05
|
| Rate for Payer: Mclaren Medicare |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Medicaid |
$0.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: PACE Medicare |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.10
|
| Rate for Payer: PHP Medicaid |
$0.05
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.14
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.14
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
| Rate for Payer: UHCCP Medicaid |
$0.05
|
| Rate for Payer: VA VA |
$0.09
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: ASR ASR |
$267.24
|
| Rate for Payer: ASR Commercial |
$267.24
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: BCBS Trust/PPO |
$225.61
|
| Rate for Payer: BCN Commercial |
$213.60
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$275.50
|
| Rate for Payer: Healthscope Whirlpool |
$267.24
|
| Rate for Payer: Mclaren Commercial |
$247.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.39
|
| Rate for Payer: Priority Health Narrow Network |
$193.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.44
|
|
