|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
NDC 50268040111
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.56
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Advantage |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: Priority Health SBD |
$2.48
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
NDC 50268040111
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.56
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Advantage |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.05
|
| Rate for Payer: UHC Exchange |
$1.55
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Advantage |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health SBD |
$5.44
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
NDC 42858020101
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Advantage |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.75
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.25
|
| Rate for Payer: UHC Core |
$127.64
|
| Rate for Payer: UHC Exchange |
$96.28
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$862.75
|
|
|
Service Code
|
NDC 68084089501
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$543.53 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.79
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Advantage |
$603.92
|
| Rate for Payer: Cofinity Commercial |
$741.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.06
|
| Rate for Payer: PHP Commercial |
$733.34
|
| Rate for Payer: Priority Health SBD |
$543.53
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Advantage |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$4.50
|
| Rate for Payer: UHC Exchange |
$3.39
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$862.75
|
|
|
Service Code
|
NDC 68084089501
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.06 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: Aetna Medicare |
$431.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.79
|
| Rate for Payer: BCBS Complete |
$345.10
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Advantage |
$603.92
|
| Rate for Payer: Cofinity Commercial |
$741.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$690.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.06
|
| Rate for Payer: PHP Commercial |
$733.34
|
| Rate for Payer: Priority Health SBD |
$543.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.79
|
| Rate for Payer: UHC Core |
$449.49
|
| Rate for Payer: UHC Exchange |
$339.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$196.88
|
|
|
Service Code
|
NDC 50268040115
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.37 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Aetna Commercial |
$167.35
|
| Rate for Payer: Aetna Medicare |
$98.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.97
|
| Rate for Payer: BCBS Complete |
$78.75
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cofinity Advantage |
$137.82
|
| Rate for Payer: Cofinity Commercial |
$169.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$177.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.66
|
| Rate for Payer: PHP Commercial |
$167.35
|
| Rate for Payer: Priority Health SBD |
$124.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.97
|
| Rate for Payer: UHC Core |
$102.57
|
| Rate for Payer: UHC Exchange |
$77.37
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$196.88
|
|
|
Service Code
|
NDC 50268040115
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.03 |
| Max. Negotiated Rate |
$177.19 |
| Rate for Payer: Aetna Commercial |
$167.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.97
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cofinity Advantage |
$137.82
|
| Rate for Payer: Cofinity Commercial |
$169.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$177.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.66
|
| Rate for Payer: PHP Commercial |
$167.35
|
| Rate for Payer: Priority Health SBD |
$124.03
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$86.28
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna Medicare |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: BCBS Complete |
$34.51
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Advantage |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.08
|
| Rate for Payer: UHC Core |
$44.95
|
| Rate for Payer: UHC Exchange |
$33.91
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$86.28
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.36 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Advantage |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health SBD |
$54.36
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.33
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$21.04
|
|
|
Service Code
|
NDC 00121231640
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.68
|
| Rate for Payer: BCBS Complete |
$8.42
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cofinity Advantage |
$14.73
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$18.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.78
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health SBD |
$13.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC Core |
$10.96
|
| Rate for Payer: UHC Exchange |
$8.27
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$8.51
|
| Rate for Payer: UHC Exchange |
$6.42
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$21.04
|
|
|
Service Code
|
NDC 00121231640
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.68
|
| Rate for Payer: Cash Price |
$16.83
|
| Rate for Payer: Cofinity Advantage |
$14.73
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.83
|
| Rate for Payer: Healthscope Commercial |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.78
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health SBD |
$13.26
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$8.51
|
| Rate for Payer: UHC Exchange |
$6.42
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$31.54
|
|
|
Service Code
|
NDC 00121477205
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.87 |
| Max. Negotiated Rate |
$28.39 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.50
|
| Rate for Payer: Cash Price |
$25.23
|
| Rate for Payer: Cofinity Advantage |
$22.08
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.23
|
| Rate for Payer: Healthscope Commercial |
$28.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.66
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: Priority Health SBD |
$19.87
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$17.96
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Medicare |
$8.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Advantage |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Core |
$9.36
|
| Rate for Payer: UHC Exchange |
$7.06
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Advantage |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health SBD |
$9.73
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689002350
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.73 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Advantage |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health SBD |
$9.73
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$17.96
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.31 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Advantage |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health SBD |
$11.31
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.33
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Advantage |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.04
|
| Rate for Payer: UHC Core |
$8.05
|
| Rate for Payer: UHC Exchange |
$6.07
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$31.54
|
|
|
Service Code
|
NDC 00121477205
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$28.39 |
| Rate for Payer: Aetna Commercial |
$26.81
|
| Rate for Payer: Aetna Medicare |
$15.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.50
|
| Rate for Payer: BCBS Complete |
$12.62
|
| Rate for Payer: Cash Price |
$25.23
|
| Rate for Payer: Cofinity Advantage |
$22.08
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.23
|
| Rate for Payer: Healthscope Commercial |
$28.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.66
|
| Rate for Payer: PHP Commercial |
$26.81
|
| Rate for Payer: Priority Health SBD |
$19.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.50
|
| Rate for Payer: UHC Core |
$16.43
|
| Rate for Payer: UHC Exchange |
$12.40
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 66689002350
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Advantage |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.04
|
| Rate for Payer: UHC Core |
$8.05
|
| Rate for Payer: UHC Exchange |
$6.07
|
|
