|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.92 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: BCBS Trust/PPO |
$213.50
|
| Rate for Payer: BCN Commercial |
$213.50
|
| 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 Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.92
|
| 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
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.88 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: BCBS Trust/PPO |
$69.87
|
| Rate for Payer: BCN Commercial |
$69.87
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$415.95
|
|
|
Service Code
|
NDC 00904744861
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna Medicare |
$108.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$129.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$129.98
|
| Rate for Payer: BCBS Complete |
$76.99
|
| Rate for Payer: BCBS MAPPO |
$103.99
|
| Rate for Payer: BCBS Trust/PPO |
$341.95
|
| Rate for Payer: BCN Commercial |
$341.95
|
| Rate for Payer: BCN Medicare Advantage |
$103.99
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.99
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Mclaren Medicaid |
$73.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.19
|
| Rate for Payer: Meridian Medicaid |
$76.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Nomi Health Commercial |
$341.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PACE Senior Care Partners |
$98.79
|
| Rate for Payer: PACE SWMI |
$103.99
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: PHP Medicare Advantage |
$103.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$361.88
|
| Rate for Payer: Priority Health Medicare |
$105.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.50
|
| Rate for Payer: Railroad Medicare Medicare |
$103.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.04
|
| Rate for Payer: UHC Core |
$347.32
|
| Rate for Payer: UHC Exchange |
$103.99
|
| Rate for Payer: UHC Medicaid |
$73.33
|
| Rate for Payer: UHC Medicare Advantage |
$103.99
|
| Rate for Payer: UHCCP Medicaid |
$73.33
|
| Rate for Payer: VA VA |
$103.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 00904744861
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: BCBS Trust/PPO |
$343.53
|
| Rate for Payer: BCN Commercial |
$343.53
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.56
|
| Rate for Payer: Nomi Health Commercial |
$341.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$311.96
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$361.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.04
|
| Rate for Payer: UHC Core |
$347.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.44
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$21.15
|
| Rate for Payer: BCBS Trust/PPO |
$69.55
|
| Rate for Payer: BCN Commercial |
$69.55
|
| Rate for Payer: BCN Medicare Advantage |
$21.15
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.15
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.21
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.09
|
| Rate for Payer: PACE SWMI |
$21.15
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: PHP Medicare Advantage |
$21.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.60
|
| Rate for Payer: Priority Health Medicare |
$21.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.45
|
| Rate for Payer: UHC Core |
$70.64
|
| Rate for Payer: UHC Exchange |
$21.15
|
| Rate for Payer: UHC Medicaid |
$14.91
|
| Rate for Payer: UHC Medicare Advantage |
$21.15
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
| Rate for Payer: VA VA |
$21.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.94 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: BCBS Trust/PPO |
$378.47
|
| Rate for Payer: BCN Commercial |
$378.47
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.79 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$119.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.20
|
| Rate for Payer: BCBS Complete |
$84.82
|
| Rate for Payer: BCBS MAPPO |
$114.56
|
| Rate for Payer: BCBS Trust/PPO |
$376.73
|
| Rate for Payer: BCN Commercial |
$376.73
|
| Rate for Payer: BCN Medicare Advantage |
$114.56
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.56
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Mclaren Medicaid |
$80.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.29
|
| Rate for Payer: Meridian Medicaid |
$84.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PACE Senior Care Partners |
$108.83
|
| Rate for Payer: PACE SWMI |
$114.56
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: PHP Medicare Advantage |
$114.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$398.68
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.94
|
| Rate for Payer: Railroad Medicare Medicare |
$114.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.26
|
| Rate for Payer: UHC Core |
$382.64
|
| Rate for Payer: UHC Exchange |
$114.56
|
| Rate for Payer: UHC Medicaid |
$80.79
|
| Rate for Payer: UHC Medicare Advantage |
$114.56
|
| Rate for Payer: UHCCP Medicaid |
$80.79
|
| Rate for Payer: VA VA |
$114.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 63739032710
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$67.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.52
|
| Rate for Payer: BCBS Complete |
$48.28
|
| Rate for Payer: BCBS MAPPO |
$65.21
|
| Rate for Payer: BCBS Trust/PPO |
$214.44
|
| Rate for Payer: BCN Commercial |
$214.44
|
| Rate for Payer: BCN Medicare Advantage |
$65.21
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.21
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Mclaren Medicaid |
$45.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.47
|
| Rate for Payer: Meridian Medicaid |
$48.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PACE Senior Care Partners |
$61.95
|
| Rate for Payer: PACE SWMI |
$65.21
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: PHP Medicare Advantage |
$65.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Medicare |
$65.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.55
|
| Rate for Payer: Railroad Medicare Medicare |
$65.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: UHC Exchange |
$65.21
|
| Rate for Payer: UHC Medicaid |
$45.99
|
| Rate for Payer: UHC Medicare Advantage |
$65.21
|
| Rate for Payer: UHCCP Medicaid |
$45.99
|
| Rate for Payer: VA VA |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Mclaren Medicaid |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: Meridian Medicaid |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.44
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicaid |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: BCBS Trust/PPO |
$58.23
|
| Rate for Payer: BCN Commercial |
$58.23
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.03
|
| Rate for Payer: BCBS Complete |
$13.05
|
| Rate for Payer: BCBS MAPPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$57.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.62
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Mclaren Medicaid |
$12.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.51
|
| Rate for Payer: Meridian Medicaid |
$13.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Nomi Health Commercial |
$57.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PACE Senior Care Partners |
$16.74
|
| Rate for Payer: PACE SWMI |
$17.62
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: PHP Medicare Advantage |
$17.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.34
|
| Rate for Payer: Priority Health Medicare |
$17.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.07
|
| Rate for Payer: Railroad Medicare Medicare |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.04
|
| Rate for Payer: UHC Core |
$58.87
|
| Rate for Payer: UHC Exchange |
$17.62
|
| Rate for Payer: UHC Medicaid |
$12.43
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
| Rate for Payer: UHCCP Medicaid |
$12.43
|
| Rate for Payer: VA VA |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$1.64
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Nomi Health Commercial |
$1.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.75
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.62
|
| Rate for Payer: BCBS Complete |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$1.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.52
|
| Rate for Payer: Meridian Medicaid |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Nomi Health Commercial |
$1.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PACE Senior Care Partners |
$0.47
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.73
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.75
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: UHC Exchange |
$0.50
|
| Rate for Payer: UHC Medicaid |
$0.35
|
| Rate for Payer: UHC Medicare Advantage |
$0.50
|
| Rate for Payer: UHCCP Medicaid |
$0.35
|
| Rate for Payer: VA VA |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicaid |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$198.55
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.05
|
| Rate for Payer: BCBS Complete |
$36.75
|
| Rate for Payer: BCBS MAPPO |
$49.64
|
| Rate for Payer: BCBS Trust/PPO |
$163.23
|
| Rate for Payer: BCN Commercial |
$163.23
|
| Rate for Payer: BCN Medicare Advantage |
$49.64
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.64
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Mclaren Medicaid |
$35.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.12
|
| Rate for Payer: Meridian Medicaid |
$36.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Nomi Health Commercial |
$162.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PACE Senior Care Partners |
$47.16
|
| Rate for Payer: PACE SWMI |
$49.64
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Medicare Advantage |
$49.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.74
|
| Rate for Payer: Priority Health Medicare |
$50.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.19
|
| Rate for Payer: Railroad Medicare Medicare |
$49.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.72
|
| Rate for Payer: UHC Core |
$165.79
|
| Rate for Payer: UHC Exchange |
$49.64
|
| Rate for Payer: UHC Medicaid |
$35.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.64
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: VA VA |
$49.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.19 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: BCBS Trust/PPO |
$163.98
|
| Rate for Payer: BCN Commercial |
$163.98
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Nomi Health Commercial |
$162.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.72
|
| Rate for Payer: UHC Core |
$165.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$46.06
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$41.45 |
| Rate for Payer: Aetna Commercial |
$39.15
|
| Rate for Payer: Aetna Medicare |
$11.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.39
|
| Rate for Payer: BCBS Complete |
$8.53
|
| Rate for Payer: BCBS MAPPO |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$37.87
|
| Rate for Payer: BCN Commercial |
$37.87
|
| Rate for Payer: BCN Medicare Advantage |
$11.52
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cofinity Commercial |
$39.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.52
|
| Rate for Payer: Healthscope Commercial |
$41.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.55
|
| Rate for Payer: Mclaren Medicaid |
$8.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.09
|
| Rate for Payer: Meridian Medicaid |
$8.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.15
|
| Rate for Payer: Nomi Health Commercial |
$37.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.55
|
| Rate for Payer: PACE Senior Care Partners |
$10.94
|
| Rate for Payer: PACE SWMI |
$11.52
|
| Rate for Payer: PHP Commercial |
$39.15
|
| Rate for Payer: PHP Medicare Advantage |
$11.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.07
|
| Rate for Payer: Priority Health Medicare |
$11.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.06
|
| Rate for Payer: Railroad Medicare Medicare |
$11.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.53
|
| Rate for Payer: UHC Core |
$38.46
|
| Rate for Payer: UHC Exchange |
$11.52
|
| Rate for Payer: UHC Medicaid |
$8.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.52
|
| Rate for Payer: UHCCP Medicaid |
$8.12
|
| Rate for Payer: VA VA |
$11.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.55
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 00406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Mclaren Medicaid |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.21
|
| Rate for Payer: Meridian Medicaid |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicaid |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 00904682561
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$477.46 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: BCBS Trust/PPO |
$566.57
|
| Rate for Payer: BCN Commercial |
$566.57
|
| 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 Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$596.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.46
|
| 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
|
$46.06
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$41.45 |
| Rate for Payer: Aetna Commercial |
$39.15
|
| Rate for Payer: BCBS Trust/PPO |
$38.04
|
| Rate for Payer: BCN Commercial |
$38.04
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cofinity Commercial |
$39.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$41.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.15
|
| Rate for Payer: Nomi Health Commercial |
$37.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.55
|
| Rate for Payer: PHP Commercial |
$39.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.53
|
| Rate for Payer: UHC Core |
$38.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.55
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
NDC 00904682561
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.94 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$178.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$214.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$214.38
|
| Rate for Payer: BCBS Complete |
$126.98
|
| Rate for Payer: BCBS MAPPO |
$171.50
|
| Rate for Payer: BCBS Trust/PPO |
$563.96
|
| Rate for Payer: BCN Commercial |
$563.96
|
| Rate for Payer: BCN Medicare Advantage |
$171.50
|
| 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: Health Alliance Plan Medicare Advantage |
$171.50
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Mclaren Medicaid |
$120.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.07
|
| Rate for Payer: Meridian Medicaid |
$126.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$188.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PACE Senior Care Partners |
$162.93
|
| Rate for Payer: PACE SWMI |
$171.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: PHP Medicare Advantage |
$171.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$596.82
|
| Rate for Payer: Priority Health Medicare |
$173.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.46
|
| Rate for Payer: Railroad Medicare Medicare |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.68
|
| Rate for Payer: UHC Core |
$572.81
|
| Rate for Payer: UHC Exchange |
$171.50
|
| Rate for Payer: UHC Medicaid |
$120.94
|
| Rate for Payer: UHC Medicare Advantage |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$120.94
|
| Rate for Payer: VA VA |
$171.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.11
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: BCBS Trust/PPO |
$5.05
|
| Rate for Payer: BCN Commercial |
$5.05
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$5.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.89
|
| Rate for Payer: Healthscope Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.19
|
| Rate for Payer: Nomi Health Commercial |
$5.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.58
|
| Rate for Payer: PHP Commercial |
$5.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.38
|
| Rate for Payer: UHC Core |
$5.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.58
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$305.38
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.54 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: Aetna Commercial |
$259.57
|
| Rate for Payer: BCBS Trust/PPO |
$252.21
|
| Rate for Payer: BCN Commercial |
$252.21
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: Cofinity Commercial |
$262.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$274.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.57
|
| Rate for Payer: Nomi Health Commercial |
$250.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.03
|
| Rate for Payer: PHP Commercial |
$259.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.73
|
| Rate for Payer: UHC Core |
$254.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.03
|
|
