|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$305.38
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$274.84 |
| Rate for Payer: Aetna Commercial |
$259.57
|
| Rate for Payer: Aetna Medicare |
$79.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.43
|
| Rate for Payer: BCBS Complete |
$56.53
|
| Rate for Payer: BCBS MAPPO |
$76.34
|
| Rate for Payer: BCBS Trust/PPO |
$251.05
|
| Rate for Payer: BCN Commercial |
$251.05
|
| Rate for Payer: BCN Medicare Advantage |
$76.34
|
| 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: Health Alliance Plan Medicare Advantage |
$76.34
|
| Rate for Payer: Healthscope Commercial |
$274.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.03
|
| Rate for Payer: Mclaren Medicaid |
$53.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.16
|
| Rate for Payer: Meridian Medicaid |
$56.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.98
|
| 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: PACE Senior Care Partners |
$72.53
|
| Rate for Payer: PACE SWMI |
$76.34
|
| Rate for Payer: PHP Commercial |
$259.57
|
| Rate for Payer: PHP Medicare Advantage |
$76.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.68
|
| Rate for Payer: Priority Health Medicare |
$77.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.54
|
| Rate for Payer: Railroad Medicare Medicare |
$76.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.73
|
| Rate for Payer: UHC Core |
$254.99
|
| Rate for Payer: UHC Exchange |
$76.34
|
| Rate for Payer: UHC Medicaid |
$53.84
|
| Rate for Payer: UHC Medicare Advantage |
$76.34
|
| Rate for Payer: UHCCP Medicaid |
$53.84
|
| Rate for Payer: VA VA |
$76.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.03
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$6.11
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$5.50 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.91
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS MAPPO |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$5.02
|
| Rate for Payer: BCN Commercial |
$5.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.53
|
| 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: Health Alliance Plan Medicare Advantage |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.58
|
| Rate for Payer: Mclaren Medicaid |
$1.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.60
|
| Rate for Payer: Meridian Medicaid |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.68
|
| 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: PACE Senior Care Partners |
$1.45
|
| Rate for Payer: PACE SWMI |
$1.53
|
| Rate for Payer: PHP Commercial |
$5.19
|
| Rate for Payer: PHP Medicare Advantage |
$1.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.32
|
| Rate for Payer: Priority Health Medicare |
$1.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.38
|
| Rate for Payer: UHC Core |
$5.10
|
| Rate for Payer: UHC Exchange |
$1.53
|
| Rate for Payer: UHC Medicaid |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.53
|
| Rate for Payer: UHCCP Medicaid |
$1.08
|
| Rate for Payer: VA VA |
$1.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.58
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 00406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| 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: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| 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: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$388.50
|
|
|
Service Code
|
NDC 00904682461
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.40 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna Commercial |
$330.23
|
| Rate for Payer: BCBS Trust/PPO |
$320.86
|
| Rate for Payer: BCN Commercial |
$320.86
|
| 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 Commercial |
$330.23
|
| Rate for Payer: Nomi Health Commercial |
$318.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.38
|
| Rate for Payer: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$338.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.40
|
| 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
|
OP
|
$388.50
|
|
|
Service Code
|
NDC 00904682461
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna Commercial |
$330.23
|
| Rate for Payer: Aetna Medicare |
$101.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.41
|
| Rate for Payer: BCBS Complete |
$71.91
|
| Rate for Payer: BCBS MAPPO |
$97.12
|
| Rate for Payer: BCBS Trust/PPO |
$319.39
|
| Rate for Payer: BCN Commercial |
$319.39
|
| Rate for Payer: BCN Medicare Advantage |
$97.12
|
| 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: Health Alliance Plan Medicare Advantage |
$97.12
|
| Rate for Payer: Healthscope Commercial |
$349.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.38
|
| Rate for Payer: Mclaren Medicaid |
$68.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.98
|
| Rate for Payer: Meridian Medicaid |
$71.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$106.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.23
|
| Rate for Payer: Nomi Health Commercial |
$318.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.38
|
| Rate for Payer: PACE Senior Care Partners |
$92.27
|
| Rate for Payer: PACE SWMI |
$97.12
|
| Rate for Payer: PHP Commercial |
$330.23
|
| Rate for Payer: PHP Medicare Advantage |
$97.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$98.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$270.40
|
| Rate for Payer: Railroad Medicare Medicare |
$97.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.88
|
| Rate for Payer: UHC Core |
$324.40
|
| Rate for Payer: UHC Exchange |
$97.12
|
| Rate for Payer: UHC Medicaid |
$68.49
|
| Rate for Payer: UHC Medicare Advantage |
$97.12
|
| Rate for Payer: UHCCP Medicaid |
$68.49
|
| Rate for Payer: VA VA |
$97.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.38
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.13
|
| Rate for Payer: BCN Commercial |
$7.13
|
| 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 Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| 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
|
OP
|
$86.28
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna Medicare |
$22.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.96
|
| Rate for Payer: BCBS Complete |
$15.97
|
| Rate for Payer: BCBS MAPPO |
$21.57
|
| Rate for Payer: BCBS Trust/PPO |
$70.93
|
| Rate for Payer: BCN Commercial |
$70.93
|
| Rate for Payer: BCN Medicare Advantage |
$21.57
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.57
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: Mclaren Medicaid |
$15.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.65
|
| Rate for Payer: Meridian Medicaid |
$15.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: Nomi Health Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: PACE Senior Care Partners |
$20.49
|
| Rate for Payer: PACE SWMI |
$21.57
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: PHP Medicare Advantage |
$21.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.06
|
| Rate for Payer: Priority Health Medicare |
$21.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.05
|
| Rate for Payer: Railroad Medicare Medicare |
$21.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.93
|
| Rate for Payer: UHC Core |
$72.04
|
| Rate for Payer: UHC Exchange |
$21.57
|
| Rate for Payer: UHC Medicaid |
$15.21
|
| Rate for Payer: UHC Medicare Advantage |
$21.57
|
| Rate for Payer: UHCCP Medicaid |
$15.21
|
| Rate for Payer: VA VA |
$21.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
|
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 |
$152.10 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: Aetna Medicare |
$224.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.61
|
| Rate for Payer: BCBS Complete |
$159.70
|
| Rate for Payer: BCBS MAPPO |
$215.69
|
| Rate for Payer: BCBS Trust/PPO |
$709.27
|
| Rate for Payer: BCN Commercial |
$709.27
|
| Rate for Payer: BCN Medicare Advantage |
$215.69
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$741.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.69
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.06
|
| Rate for Payer: Mclaren Medicaid |
$152.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.47
|
| Rate for Payer: Meridian Medicaid |
$159.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.06
|
| Rate for Payer: PACE Senior Care Partners |
$204.90
|
| Rate for Payer: PACE SWMI |
$215.69
|
| Rate for Payer: PHP Commercial |
$733.34
|
| Rate for Payer: PHP Medicare Advantage |
$215.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$750.59
|
| Rate for Payer: Priority Health Medicare |
$217.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$600.47
|
| Rate for Payer: Railroad Medicare Medicare |
$215.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.22
|
| Rate for Payer: UHC Core |
$720.40
|
| Rate for Payer: UHC Exchange |
$215.69
|
| Rate for Payer: UHC Medicaid |
$152.10
|
| Rate for Payer: UHC Medicare Advantage |
$215.69
|
| Rate for Payer: UHCCP Medicaid |
$152.10
|
| Rate for Payer: VA VA |
$215.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.06
|
|
|
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 |
$60.05 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: BCBS Trust/PPO |
$71.26
|
| Rate for Payer: BCN Commercial |
$71.26
|
| Rate for Payer: Cash Price |
$69.02
|
| 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: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: Nomi Health Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$75.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.93
|
| Rate for Payer: UHC Core |
$72.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,461.25
|
|
|
Service Code
|
NDC 10702018950
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,017.03 |
| Max. Negotiated Rate |
$1,315.12 |
| Rate for Payer: Aetna Commercial |
$1,242.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.85
|
| Rate for Payer: BCN Commercial |
$1,206.85
|
| Rate for Payer: Cash Price |
$1,169.00
|
| Rate for Payer: Cofinity Commercial |
$1,256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,169.00
|
| Rate for Payer: Healthscope Commercial |
$1,315.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,095.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,242.06
|
| Rate for Payer: Nomi Health Commercial |
$1,198.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.94
|
| Rate for Payer: PHP Commercial |
$1,242.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,271.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,017.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,285.90
|
| Rate for Payer: UHC Core |
$1,220.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,095.94
|
|
|
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 |
$600.47 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: BCBS Trust/PPO |
$712.55
|
| Rate for Payer: BCN Commercial |
$712.55
|
| Rate for Payer: Cash Price |
$690.20
|
| 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: Lakeland Regional Health Systems Commercial |
$647.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.06
|
| Rate for Payer: PHP Commercial |
$733.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$750.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$600.47
|
| 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
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| 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: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Mclaren Medicaid |
$1.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: Meridian Medicaid |
$1.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PACE Senior Care Partners |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Medicaid |
$1.52
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| Rate for Payer: UHCCP Medicaid |
$1.52
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
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 |
$1.52 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.16
|
| 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: Health Alliance Plan Medicare Advantage |
$2.16
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Mclaren Medicaid |
$1.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: Meridian Medicaid |
$1.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PACE Senior Care Partners |
$2.05
|
| Rate for Payer: PACE SWMI |
$2.16
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: PHP Medicare Advantage |
$2.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| Rate for Payer: Railroad Medicare Medicare |
$2.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Medicaid |
$1.52
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| Rate for Payer: UHCCP Medicaid |
$1.52
|
| Rate for Payer: VA VA |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
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 |
$6.01 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.13
|
| Rate for Payer: BCN Commercial |
$7.13
|
| 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 Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.01
|
| 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
|
OP
|
$1,461.25
|
|
|
Service Code
|
NDC 10702018950
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.62 |
| Max. Negotiated Rate |
$1,315.12 |
| Rate for Payer: Aetna Commercial |
$1,242.06
|
| Rate for Payer: Aetna Medicare |
$379.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$456.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$456.64
|
| Rate for Payer: BCBS Complete |
$270.48
|
| Rate for Payer: BCBS MAPPO |
$365.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.29
|
| Rate for Payer: BCN Commercial |
$1,201.29
|
| Rate for Payer: BCN Medicare Advantage |
$365.31
|
| Rate for Payer: Cash Price |
$1,169.00
|
| Rate for Payer: Cofinity Commercial |
$1,256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,169.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.31
|
| Rate for Payer: Healthscope Commercial |
$1,315.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,095.94
|
| Rate for Payer: Mclaren Medicaid |
$257.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$383.58
|
| Rate for Payer: Meridian Medicaid |
$270.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$420.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$401.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,242.06
|
| Rate for Payer: Nomi Health Commercial |
$1,198.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.94
|
| Rate for Payer: PACE Senior Care Partners |
$347.05
|
| Rate for Payer: PACE SWMI |
$365.31
|
| Rate for Payer: PHP Commercial |
$1,242.06
|
| Rate for Payer: PHP Medicare Advantage |
$365.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,271.29
|
| Rate for Payer: Priority Health Medicare |
$368.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,017.03
|
| Rate for Payer: Railroad Medicare Medicare |
$365.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,285.90
|
| Rate for Payer: UHC Core |
$1,220.14
|
| Rate for Payer: UHC Exchange |
$365.31
|
| Rate for Payer: UHC Medicaid |
$257.62
|
| Rate for Payer: UHC Medicare Advantage |
$365.31
|
| Rate for Payer: UHCCP Medicaid |
$257.62
|
| Rate for Payer: VA VA |
$365.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,095.94
|
|
|
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 |
$10.75 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: BCBS Trust/PPO |
$12.76
|
| Rate for Payer: BCN Commercial |
$12.76
|
| Rate for Payer: Cash Price |
$12.36
|
| 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: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
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 |
$2.72 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.83
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: BCBS MAPPO |
$3.86
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.86
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.86
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Mclaren Medicaid |
$2.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.06
|
| Rate for Payer: Meridian Medicaid |
$2.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PACE Senior Care Partners |
$3.67
|
| Rate for Payer: PACE SWMI |
$3.86
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: PHP Medicare Advantage |
$3.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Medicare |
$3.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: UHC Exchange |
$3.86
|
| Rate for Payer: UHC Medicaid |
$2.72
|
| Rate for Payer: UHC Medicare Advantage |
$3.86
|
| Rate for Payer: UHCCP Medicaid |
$2.72
|
| Rate for Payer: VA VA |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
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 |
$2.88 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$4.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.10
|
| Rate for Payer: BCBS Complete |
$3.02
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$13.42
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Mclaren Medicaid |
$2.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.29
|
| Rate for Payer: Meridian Medicaid |
$3.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Nomi Health Commercial |
$13.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PACE Senior Care Partners |
$3.88
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.21
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.37
|
| Rate for Payer: UHC Core |
$13.64
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Medicaid |
$2.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: UHCCP Medicaid |
$2.88
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
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 |
$10.75 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: BCBS Trust/PPO |
$12.76
|
| Rate for Payer: BCN Commercial |
$12.76
|
| Rate for Payer: Cash Price |
$12.36
|
| 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: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
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 |
$11.37 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: BCBS Trust/PPO |
$13.49
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: Cash Price |
$13.06
|
| 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: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Nomi Health Commercial |
$13.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.37
|
| Rate for Payer: UHC Core |
$13.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$10.13
|
|
|
Service Code
|
NDC 09900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$2.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.17
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$8.33
|
| Rate for Payer: BCN Medicare Advantage |
$2.53
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Mclaren Medicaid |
$1.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.66
|
| Rate for Payer: Meridian Medicaid |
$1.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$8.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.60
|
| Rate for Payer: PACE Senior Care Partners |
$2.41
|
| Rate for Payer: PACE SWMI |
$2.53
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$2.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.81
|
| Rate for Payer: Priority Health Medicare |
$2.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.05
|
| Rate for Payer: Railroad Medicare Medicare |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: UHC Exchange |
$2.53
|
| Rate for Payer: UHC Medicaid |
$1.79
|
| Rate for Payer: UHC Medicare Advantage |
$2.53
|
| Rate for Payer: UHCCP Medicaid |
$1.79
|
| Rate for Payer: VA VA |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$10.13
|
|
|
Service Code
|
NDC 09900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.37
|
| Rate for Payer: BCN Commercial |
$8.37
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$8.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.60
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
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 |
$14.64 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCN Commercial |
$17.38
|
| Rate for Payer: Cash Price |
$16.83
|
| 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: Lakeland Regional Health Systems Commercial |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: Nomi Health Commercial |
$17.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.78
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.52
|
| Rate for Payer: UHC Core |
$17.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.78
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$40.11
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.53
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS MAPPO |
$10.03
|
| Rate for Payer: BCBS Trust/PPO |
$32.97
|
| Rate for Payer: BCN Commercial |
$32.97
|
| Rate for Payer: BCN Medicare Advantage |
$10.03
|
| Rate for Payer: Cash Price |
$32.09
|
| Rate for Payer: Cofinity Commercial |
$34.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.03
|
| Rate for Payer: Healthscope Commercial |
$36.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.08
|
| Rate for Payer: Mclaren Medicaid |
$7.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.53
|
| Rate for Payer: Meridian Medicaid |
$7.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.09
|
| Rate for Payer: Nomi Health Commercial |
$32.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.08
|
| Rate for Payer: PACE Senior Care Partners |
$9.53
|
| Rate for Payer: PACE SWMI |
$10.03
|
| Rate for Payer: PHP Commercial |
$34.09
|
| Rate for Payer: PHP Medicare Advantage |
$10.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.90
|
| Rate for Payer: Priority Health Medicare |
$10.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.92
|
| Rate for Payer: Railroad Medicare Medicare |
$10.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.30
|
| Rate for Payer: UHC Core |
$33.49
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UHC Medicaid |
$7.07
|
| Rate for Payer: UHC Medicare Advantage |
$10.03
|
| Rate for Payer: UHCCP Medicaid |
$7.07
|
| Rate for Payer: VA VA |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.08
|
|
|
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 |
$2.72 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.83
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: BCBS MAPPO |
$3.86
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.70
|
| Rate for Payer: BCN Medicare Advantage |
$3.86
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.86
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Mclaren Medicaid |
$2.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.06
|
| Rate for Payer: Meridian Medicaid |
$2.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PACE Senior Care Partners |
$3.67
|
| Rate for Payer: PACE SWMI |
$3.86
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: PHP Medicare Advantage |
$3.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Medicare |
$3.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: UHC Exchange |
$3.86
|
| Rate for Payer: UHC Medicaid |
$2.72
|
| Rate for Payer: UHC Medicare Advantage |
$3.86
|
| Rate for Payer: UHCCP Medicaid |
$2.72
|
| Rate for Payer: VA VA |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
