|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$686.17
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.97 |
| Max. Negotiated Rate |
$617.55 |
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna Medicare |
$178.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.43
|
| Rate for Payer: BCBS Complete |
$274.65
|
| Rate for Payer: BCBS MAPPO |
$171.54
|
| Rate for Payer: BCBS Trust/PPO |
$533.50
|
| Rate for Payer: BCN Commercial |
$533.50
|
| Rate for Payer: BCN Medicare Advantage |
$171.54
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cofinity Commercial |
$590.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.54
|
| Rate for Payer: Healthscope Commercial |
$617.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.63
|
| Rate for Payer: Mclaren Medicaid |
$261.57
|
| Rate for Payer: Meridian Medicaid |
$274.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$180.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.24
|
| Rate for Payer: PACE Senior Care Partners |
$162.97
|
| Rate for Payer: PACE SWMI |
$171.54
|
| Rate for Payer: PHP Commercial |
$583.24
|
| Rate for Payer: PHP Medicare Advantage |
$171.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.97
|
| Rate for Payer: Priority Health Medicare |
$171.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.50
|
| Rate for Payer: Railroad Medicare Medicare |
$171.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.83
|
| Rate for Payer: UHC Core |
$572.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.54
|
| Rate for Payer: UHC Medicare Advantage |
$176.69
|
| Rate for Payer: VA VA |
$171.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.63
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$686.17
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$418.50 |
| Max. Negotiated Rate |
$617.55 |
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: BCBS Trust/PPO |
$530.27
|
| Rate for Payer: BCN Commercial |
$530.27
|
| Rate for Payer: Cash Price |
$548.94
|
| Rate for Payer: Cofinity Commercial |
$590.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.94
|
| Rate for Payer: Healthscope Commercial |
$617.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.24
|
| Rate for Payer: PHP Commercial |
$583.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.83
|
| Rate for Payer: UHC Core |
$572.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.63
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.24
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.82
|
| Rate for Payer: BCN Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.30
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.49
|
| Rate for Payer: UHC Core |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.24
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.62 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.95
|
| Rate for Payer: BCBS Complete |
$2.50
|
| Rate for Payer: BCBS MAPPO |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$4.85
|
| Rate for Payer: BCN Commercial |
$4.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.56
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cofinity Commercial |
$5.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.56
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.30
|
| Rate for Payer: PACE Senior Care Partners |
$1.48
|
| Rate for Payer: PACE SWMI |
$1.56
|
| Rate for Payer: PHP Commercial |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.43
|
| Rate for Payer: Priority Health Medicare |
$1.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.49
|
| Rate for Payer: UHC Core |
$5.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.56
|
| Rate for Payer: UHC Medicare Advantage |
$1.61
|
| Rate for Payer: VA VA |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.68
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.19
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.34
|
| Rate for Payer: UHC Core |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.98 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: BCBS Trust/PPO |
$127.95
|
| Rate for Payer: BCN Commercial |
$127.95
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.70
|
| Rate for Payer: UHC Core |
$138.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 0904-6440-61
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.03 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: BCBS Trust/PPO |
$176.16
|
| Rate for Payer: BCN Commercial |
$176.16
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.76
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084-447-11
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.69 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: BCBS Trust/PPO |
$266.96
|
| Rate for Payer: BCN Commercial |
$266.96
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.00
|
| Rate for Payer: UHC Core |
$288.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.27
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.19 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: BCBS Trust/PPO |
$17.98
|
| Rate for Payer: BCN Commercial |
$17.98
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.78
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 0904-6441-61
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.66 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: BCBS Trust/PPO |
$199.77
|
| Rate for Payer: BCN Commercial |
$199.77
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.48
|
| Rate for Payer: UHC Core |
$215.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 50228-146-01
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$45.40
|
| Rate for Payer: BCN Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 51079-776-01
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.71
|
| Rate for Payer: UHC Core |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 51079-776-20
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.76 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: BCBS Trust/PPO |
$237.91
|
| Rate for Payer: BCN Commercial |
$237.91
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.67
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 16729-183-01
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.63 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: BCBS Trust/PPO |
$23.61
|
| Rate for Payer: BCN Commercial |
$23.61
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.88
|
| Rate for Payer: UHC Core |
$25.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 63739-128-10
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: BCBS Trust/PPO |
$45.40
|
| Rate for Payer: BCN Commercial |
$45.40
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.70
|
| Rate for Payer: UHC Core |
$49.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$363.13
|
|
|
Service Code
|
NDC 50268-402-15
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.47 |
| Max. Negotiated Rate |
$326.82 |
| Rate for Payer: Aetna Commercial |
$308.66
|
| Rate for Payer: BCBS Trust/PPO |
$280.63
|
| Rate for Payer: BCN Commercial |
$280.63
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: Cofinity Commercial |
$312.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.50
|
| Rate for Payer: Healthscope Commercial |
$326.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$308.66
|
| Rate for Payer: PHP Commercial |
$308.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.55
|
| Rate for Payer: UHC Core |
$303.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.35
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$7.27
|
|
|
Service Code
|
NDC 50268-402-11
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Aetna Commercial |
$6.18
|
| Rate for Payer: BCBS Trust/PPO |
$5.62
|
| Rate for Payer: BCN Commercial |
$5.62
|
| Rate for Payer: Cash Price |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$6.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$6.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.18
|
| Rate for Payer: PHP Commercial |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.40
|
| Rate for Payer: UHC Core |
$6.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.45
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.11
|
|
|
Service Code
|
NDC 0406-0125-23
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Aetna Commercial |
$6.89
|
| Rate for Payer: BCBS Trust/PPO |
$6.27
|
| Rate for Payer: BCN Commercial |
$6.27
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cofinity Commercial |
$6.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$7.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.89
|
| Rate for Payer: PHP Commercial |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.14
|
| Rate for Payer: UHC Core |
$6.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.08
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 0904-6825-61
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$418.39 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: BCBS Trust/PPO |
$530.14
|
| Rate for Payer: BCN Commercial |
$530.14
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.10
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$418.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.68
|
| Rate for Payer: UHC Core |
$572.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$81.03
|
|
|
Service Code
|
NDC 0406-0125-62
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna Commercial |
$68.88
|
| Rate for Payer: BCBS Trust/PPO |
$62.62
|
| Rate for Payer: BCN Commercial |
$62.62
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$69.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Healthscope Commercial |
$72.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.88
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.31
|
| Rate for Payer: UHC Core |
$67.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.77
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$862.75
|
|
|
Service Code
|
NDC 68084-895-01
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$526.19 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: BCBS Trust/PPO |
$666.73
|
| Rate for Payer: BCN Commercial |
$666.73
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$741.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$733.34
|
| Rate for Payer: PHP Commercial |
$733.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$750.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$526.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.22
|
| Rate for Payer: UHC Core |
$720.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 68084-895-11
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$6.67
|
| Rate for Payer: BCN Commercial |
$6.67
|
| Rate for Payer: Cash Price |
$6.90
|
| 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: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.92
|
|
|
Service Code
|
NDC 0406-0123-23
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Aetna Commercial |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.35
|
| Rate for Payer: BCN Commercial |
$5.35
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.54
|
| Rate for Payer: Healthscope Commercial |
$6.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.88
|
| Rate for Payer: PHP Commercial |
$5.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.09
|
| Rate for Payer: UHC Core |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.19
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$388.50
|
|
|
Service Code
|
NDC 0904-6824-61
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.95 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: BCBS Trust/PPO |
$300.23
|
| Rate for Payer: BCN Commercial |
$300.23
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.80
|
| Rate for Payer: Healthscope Commercial |
$349.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.22
|
| Rate for Payer: PHP Commercial |
$330.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.88
|
| Rate for Payer: UHC Core |
$324.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.38
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$69.13
|
|
|
Service Code
|
NDC 0406-0123-62
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.16 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$58.76
|
| Rate for Payer: BCBS Trust/PPO |
$53.42
|
| Rate for Payer: BCN Commercial |
$53.42
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.30
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.76
|
| Rate for Payer: PHP Commercial |
$58.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.83
|
| Rate for Payer: UHC Core |
$57.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.85
|
|
