|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$17.96
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Medicare |
$4.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.61
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: BCBS MAPPO |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.49
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.49
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: Mclaren Medicaid |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.71
|
| Rate for Payer: Meridian Medicaid |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Nomi Health Commercial |
$14.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PACE Senior Care Partners |
$4.27
|
| Rate for Payer: PACE SWMI |
$4.49
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.63
|
| Rate for Payer: Priority Health Medicare |
$4.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.80
|
| Rate for Payer: UHC Core |
$15.00
|
| Rate for Payer: UHC Exchange |
$4.49
|
| Rate for Payer: UHC Medicaid |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$4.49
|
| Rate for Payer: UHCCP Medicaid |
$3.17
|
| Rate for Payer: VA VA |
$4.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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
|
OP
|
$21.04
|
|
|
Service Code
|
NDC 00121231640
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.58
|
| Rate for Payer: BCBS Complete |
$3.89
|
| Rate for Payer: BCBS MAPPO |
$5.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.30
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.26
|
| 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: Health Alliance Plan Medicare Advantage |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$18.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.78
|
| Rate for Payer: Mclaren Medicaid |
$3.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.52
|
| Rate for Payer: Meridian Medicaid |
$3.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.79
|
| 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: PACE Senior Care Partners |
$5.00
|
| Rate for Payer: PACE SWMI |
$5.26
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: PHP Medicare Advantage |
$5.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.30
|
| Rate for Payer: Priority Health Medicare |
$5.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.64
|
| Rate for Payer: Railroad Medicare Medicare |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.52
|
| Rate for Payer: UHC Core |
$17.57
|
| Rate for Payer: UHC Exchange |
$5.26
|
| Rate for Payer: UHC Medicaid |
$3.71
|
| Rate for Payer: UHC Medicare Advantage |
$5.26
|
| Rate for Payer: UHCCP Medicaid |
$3.71
|
| Rate for Payer: VA VA |
$5.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.78
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.33
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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
|
IP
|
$17.96
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: BCBS Trust/PPO |
$14.83
|
| Rate for Payer: BCN Commercial |
$14.83
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Nomi Health Commercial |
$14.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.80
|
| Rate for Payer: UHC Core |
$15.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$40.11
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: BCBS Trust/PPO |
$33.13
|
| Rate for Payer: BCN Commercial |
$33.13
|
| 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: Healthscope Commercial |
$36.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.08
|
| 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: PHP Commercial |
$34.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$34.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.30
|
| Rate for Payer: UHC Core |
$33.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.08
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$990.50
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$689.39 |
| Max. Negotiated Rate |
$891.45 |
| Rate for Payer: Aetna Commercial |
$841.92
|
| Rate for Payer: BCBS Trust/PPO |
$818.05
|
| Rate for Payer: BCN Commercial |
$818.05
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: Cofinity Commercial |
$851.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.40
|
| Rate for Payer: Healthscope Commercial |
$891.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$742.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.92
|
| Rate for Payer: Nomi Health Commercial |
$812.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.88
|
| Rate for Payer: PHP Commercial |
$841.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$861.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.64
|
| Rate for Payer: UHC Core |
$827.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$742.88
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: BCBS Trust/PPO |
$8.18
|
| Rate for Payer: BCN Commercial |
$8.18
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.93
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.43
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.72
|
| Rate for Payer: UHC Core |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.43
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
NDC 65162011510
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.51 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: BCBS Trust/PPO |
$281.84
|
| Rate for Payer: BCN Commercial |
$281.84
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.94
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$296.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.30
|
| Rate for Payer: UHC Core |
$284.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$990.50
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.63 |
| Max. Negotiated Rate |
$891.45 |
| Rate for Payer: Aetna Commercial |
$841.92
|
| Rate for Payer: Aetna Medicare |
$257.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$309.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$309.53
|
| Rate for Payer: BCBS Complete |
$183.34
|
| Rate for Payer: BCBS MAPPO |
$247.62
|
| Rate for Payer: BCBS Trust/PPO |
$814.29
|
| Rate for Payer: BCN Commercial |
$814.29
|
| Rate for Payer: BCN Medicare Advantage |
$247.62
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: Cofinity Commercial |
$851.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.62
|
| Rate for Payer: Healthscope Commercial |
$891.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$742.88
|
| Rate for Payer: Mclaren Medicaid |
$174.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.01
|
| Rate for Payer: Meridian Medicaid |
$183.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$272.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.92
|
| Rate for Payer: Nomi Health Commercial |
$812.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.88
|
| Rate for Payer: PACE Senior Care Partners |
$235.24
|
| Rate for Payer: PACE SWMI |
$247.62
|
| Rate for Payer: PHP Commercial |
$841.92
|
| Rate for Payer: PHP Medicare Advantage |
$247.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$861.74
|
| Rate for Payer: Priority Health Medicare |
$250.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.39
|
| Rate for Payer: Railroad Medicare Medicare |
$247.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$871.64
|
| Rate for Payer: UHC Core |
$827.07
|
| Rate for Payer: UHC Exchange |
$247.62
|
| Rate for Payer: UHC Medicaid |
$174.63
|
| Rate for Payer: UHC Medicare Advantage |
$247.62
|
| Rate for Payer: UHCCP Medicaid |
$174.63
|
| Rate for Payer: VA VA |
$247.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$742.88
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$537.25
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$483.52 |
| Rate for Payer: Aetna Commercial |
$456.66
|
| Rate for Payer: Aetna Medicare |
$139.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$167.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$167.89
|
| Rate for Payer: BCBS Complete |
$99.44
|
| Rate for Payer: BCBS MAPPO |
$134.31
|
| Rate for Payer: BCBS Trust/PPO |
$441.67
|
| Rate for Payer: BCN Commercial |
$441.67
|
| Rate for Payer: BCN Medicare Advantage |
$134.31
|
| Rate for Payer: Cash Price |
$429.80
|
| Rate for Payer: Cofinity Commercial |
$462.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.31
|
| Rate for Payer: Healthscope Commercial |
$483.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.94
|
| Rate for Payer: Mclaren Medicaid |
$94.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.03
|
| Rate for Payer: Meridian Medicaid |
$99.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.66
|
| Rate for Payer: Nomi Health Commercial |
$440.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.94
|
| Rate for Payer: PACE Senior Care Partners |
$127.60
|
| Rate for Payer: PACE SWMI |
$134.31
|
| Rate for Payer: PHP Commercial |
$456.66
|
| Rate for Payer: PHP Medicare Advantage |
$134.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$467.41
|
| Rate for Payer: Priority Health Medicare |
$135.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$373.93
|
| Rate for Payer: Railroad Medicare Medicare |
$134.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.78
|
| Rate for Payer: UHC Core |
$448.60
|
| Rate for Payer: UHC Exchange |
$134.31
|
| Rate for Payer: UHC Medicaid |
$94.72
|
| Rate for Payer: UHC Medicare Advantage |
$134.31
|
| Rate for Payer: UHCCP Medicaid |
$94.72
|
| Rate for Payer: VA VA |
$134.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$537.25
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$373.93 |
| Max. Negotiated Rate |
$483.52 |
| Rate for Payer: Aetna Commercial |
$456.66
|
| Rate for Payer: BCBS Trust/PPO |
$443.71
|
| Rate for Payer: BCN Commercial |
$443.71
|
| Rate for Payer: Cash Price |
$429.80
|
| Rate for Payer: Cofinity Commercial |
$462.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.80
|
| Rate for Payer: Healthscope Commercial |
$483.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.66
|
| Rate for Payer: Nomi Health Commercial |
$440.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.94
|
| Rate for Payer: PHP Commercial |
$456.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$467.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$373.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.78
|
| Rate for Payer: UHC Core |
$448.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$530.25
|
|
|
Service Code
|
NDC 00904682661
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$477.23 |
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.70
|
| Rate for Payer: BCBS Complete |
$98.15
|
| Rate for Payer: BCBS MAPPO |
$132.56
|
| Rate for Payer: BCBS Trust/PPO |
$435.92
|
| Rate for Payer: BCN Commercial |
$435.92
|
| Rate for Payer: BCN Medicare Advantage |
$132.56
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.56
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: Mclaren Medicaid |
$93.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.19
|
| Rate for Payer: Meridian Medicaid |
$98.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.71
|
| Rate for Payer: Nomi Health Commercial |
$434.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.69
|
| Rate for Payer: PACE Senior Care Partners |
$125.93
|
| Rate for Payer: PACE SWMI |
$132.56
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: PHP Medicare Advantage |
$132.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$461.32
|
| Rate for Payer: Priority Health Medicare |
$133.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.05
|
| Rate for Payer: Railroad Medicare Medicare |
$132.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.62
|
| Rate for Payer: UHC Core |
$442.76
|
| Rate for Payer: UHC Exchange |
$132.56
|
| Rate for Payer: UHC Medicaid |
$93.48
|
| Rate for Payer: UHC Medicare Advantage |
$132.56
|
| Rate for Payer: UHCCP Medicaid |
$93.48
|
| Rate for Payer: VA VA |
$132.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
NDC 65162011510
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$88.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.64
|
| Rate for Payer: BCBS Complete |
$63.17
|
| Rate for Payer: BCBS MAPPO |
$85.31
|
| Rate for Payer: BCBS Trust/PPO |
$280.54
|
| Rate for Payer: BCN Commercial |
$280.54
|
| Rate for Payer: BCN Medicare Advantage |
$85.31
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.31
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Mclaren Medicaid |
$60.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.58
|
| Rate for Payer: Meridian Medicaid |
$63.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.94
|
| Rate for Payer: PACE Senior Care Partners |
$81.05
|
| Rate for Payer: PACE SWMI |
$85.31
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: PHP Medicare Advantage |
$85.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$296.89
|
| Rate for Payer: Priority Health Medicare |
$86.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.51
|
| Rate for Payer: Railroad Medicare Medicare |
$85.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.30
|
| Rate for Payer: UHC Core |
$284.94
|
| Rate for Payer: UHC Exchange |
$85.31
|
| Rate for Payer: UHC Medicaid |
$60.16
|
| Rate for Payer: UHC Medicare Advantage |
$85.31
|
| Rate for Payer: UHCCP Medicaid |
$60.16
|
| Rate for Payer: VA VA |
$85.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$530.25
|
|
|
Service Code
|
NDC 00904682661
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$369.05 |
| Max. Negotiated Rate |
$477.23 |
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: BCBS Trust/PPO |
$437.93
|
| Rate for Payer: BCN Commercial |
$437.93
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.71
|
| Rate for Payer: Nomi Health Commercial |
$434.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.69
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$461.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$369.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.62
|
| Rate for Payer: UHC Core |
$442.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Medicare |
$2.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.10
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS MAPPO |
$2.48
|
| Rate for Payer: BCBS Trust/PPO |
$8.15
|
| Rate for Payer: BCN Commercial |
$8.15
|
| Rate for Payer: BCN Medicare Advantage |
$2.48
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.48
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.43
|
| Rate for Payer: Mclaren Medicaid |
$1.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.60
|
| Rate for Payer: Meridian Medicaid |
$1.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.43
|
| Rate for Payer: PACE Senior Care Partners |
$2.35
|
| Rate for Payer: PACE SWMI |
$2.48
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: PHP Medicare Advantage |
$2.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.62
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.90
|
| Rate for Payer: Railroad Medicare Medicare |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.72
|
| Rate for Payer: UHC Core |
$8.27
|
| Rate for Payer: UHC Exchange |
$2.48
|
| Rate for Payer: UHC Medicaid |
$1.75
|
| Rate for Payer: UHC Medicare Advantage |
$2.48
|
| Rate for Payer: UHCCP Medicaid |
$1.75
|
| Rate for Payer: VA VA |
$2.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.43
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$157.33
|
|
|
Service Code
|
NDC 68455010270
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: BCBS Trust/PPO |
$129.94
|
| Rate for Payer: BCN Commercial |
$129.94
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cofinity Commercial |
$135.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.86
|
| Rate for Payer: Healthscope Commercial |
$141.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.73
|
| Rate for Payer: Nomi Health Commercial |
$129.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.00
|
| Rate for Payer: PHP Commercial |
$133.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.45
|
| Rate for Payer: UHC Core |
$131.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.00
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$157.33
|
|
|
Service Code
|
NDC 68455010270
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.74 |
| Max. Negotiated Rate |
$141.60 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Aetna Medicare |
$40.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.17
|
| Rate for Payer: BCBS Complete |
$29.12
|
| Rate for Payer: BCBS MAPPO |
$39.33
|
| Rate for Payer: BCBS Trust/PPO |
$129.34
|
| Rate for Payer: BCN Commercial |
$129.34
|
| Rate for Payer: BCN Medicare Advantage |
$39.33
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cofinity Commercial |
$135.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.33
|
| Rate for Payer: Healthscope Commercial |
$141.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.00
|
| Rate for Payer: Mclaren Medicaid |
$27.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.30
|
| Rate for Payer: Meridian Medicaid |
$29.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.73
|
| Rate for Payer: Nomi Health Commercial |
$129.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.00
|
| Rate for Payer: PACE Senior Care Partners |
$37.37
|
| Rate for Payer: PACE SWMI |
$39.33
|
| Rate for Payer: PHP Commercial |
$133.73
|
| Rate for Payer: PHP Medicare Advantage |
$39.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.88
|
| Rate for Payer: Priority Health Medicare |
$39.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$109.50
|
| Rate for Payer: Railroad Medicare Medicare |
$39.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.45
|
| Rate for Payer: UHC Core |
$131.37
|
| Rate for Payer: UHC Exchange |
$39.33
|
| Rate for Payer: UHC Medicaid |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$39.33
|
| Rate for Payer: UHCCP Medicaid |
$27.74
|
| Rate for Payer: VA VA |
$39.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.00
|
|
|
HYDROCOLLOID DRESSING 6" X 6"
|
Facility
|
IP
|
$68.55
|
|
|
Service Code
|
NDC 68455010271
|
| Hospital Charge Code |
111013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: BCBS Trust/PPO |
$56.62
|
| Rate for Payer: BCN Commercial |
$56.62
|
| Rate for Payer: Cash Price |
$54.84
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.84
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.27
|
| Rate for Payer: Nomi Health Commercial |
$56.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.41
|
| Rate for Payer: PHP Commercial |
$58.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.32
|
| Rate for Payer: UHC Core |
$57.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.41
|
|
|
HYDROCOLLOID DRESSING 6" X 6"
|
Facility
|
OP
|
$68.55
|
|
|
Service Code
|
NDC 68455010271
|
| Hospital Charge Code |
111013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: Aetna Medicare |
$17.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.42
|
| Rate for Payer: BCBS Complete |
$12.69
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$56.35
|
| Rate for Payer: BCN Commercial |
$56.35
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$54.84
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.41
|
| Rate for Payer: Mclaren Medicaid |
$12.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.99
|
| Rate for Payer: Meridian Medicaid |
$12.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.27
|
| Rate for Payer: Nomi Health Commercial |
$56.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.41
|
| Rate for Payer: PACE Senior Care Partners |
$16.28
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Commercial |
$58.27
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.64
|
| Rate for Payer: Priority Health Medicare |
$17.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.71
|
| Rate for Payer: Railroad Medicare Medicare |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.32
|
| Rate for Payer: UHC Core |
$57.24
|
| Rate for Payer: UHC Exchange |
$17.14
|
| Rate for Payer: UHC Medicaid |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
| Rate for Payer: UHCCP Medicaid |
$12.09
|
| Rate for Payer: VA VA |
$17.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.41
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$709.92
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$638.93 |
| Rate for Payer: Aetna Commercial |
$603.43
|
| Rate for Payer: Aetna Medicare |
$184.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.85
|
| Rate for Payer: BCBS Complete |
$131.41
|
| Rate for Payer: BCBS MAPPO |
$177.48
|
| Rate for Payer: BCBS Trust/PPO |
$583.63
|
| Rate for Payer: BCN Commercial |
$583.63
|
| Rate for Payer: BCN Medicare Advantage |
$177.48
|
| Rate for Payer: Cash Price |
$567.94
|
| Rate for Payer: Cofinity Commercial |
$610.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.48
|
| Rate for Payer: Healthscope Commercial |
$638.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.44
|
| Rate for Payer: Mclaren Medicaid |
$125.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.35
|
| Rate for Payer: Meridian Medicaid |
$131.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.43
|
| Rate for Payer: Nomi Health Commercial |
$582.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.44
|
| Rate for Payer: PACE Senior Care Partners |
$168.61
|
| Rate for Payer: PACE SWMI |
$177.48
|
| Rate for Payer: PHP Commercial |
$603.43
|
| Rate for Payer: PHP Medicare Advantage |
$177.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$617.63
|
| Rate for Payer: Priority Health Medicare |
$179.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.10
|
| Rate for Payer: Railroad Medicare Medicare |
$177.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.73
|
| Rate for Payer: UHC Core |
$592.78
|
| Rate for Payer: UHC Exchange |
$177.48
|
| Rate for Payer: UHC Medicaid |
$125.16
|
| Rate for Payer: UHC Medicare Advantage |
$177.48
|
| Rate for Payer: UHCCP Medicaid |
$125.16
|
| Rate for Payer: VA VA |
$177.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.44
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$709.92
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$494.10 |
| Max. Negotiated Rate |
$638.93 |
| Rate for Payer: Aetna Commercial |
$603.43
|
| Rate for Payer: BCBS Trust/PPO |
$586.32
|
| Rate for Payer: BCN Commercial |
$586.32
|
| Rate for Payer: Cash Price |
$567.94
|
| Rate for Payer: Cofinity Commercial |
$610.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.94
|
| Rate for Payer: Healthscope Commercial |
$638.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$532.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.43
|
| Rate for Payer: Nomi Health Commercial |
$582.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.44
|
| Rate for Payer: PHP Commercial |
$603.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$617.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.73
|
| Rate for Payer: UHC Core |
$592.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$532.44
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 00113054164
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$8.33
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Nomi Health Commercial |
$8.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.87
|
| Rate for Payer: UHC Core |
$8.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.56
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 00113054164
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$2.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.15
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: BCBS MAPPO |
$2.52
|
| Rate for Payer: BCBS Trust/PPO |
$8.29
|
| Rate for Payer: BCN Commercial |
$8.29
|
| Rate for Payer: BCN Medicare Advantage |
$2.52
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.52
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.56
|
| Rate for Payer: Mclaren Medicaid |
$1.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.65
|
| Rate for Payer: Meridian Medicaid |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Nomi Health Commercial |
$8.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PACE Senior Care Partners |
$2.39
|
| Rate for Payer: PACE SWMI |
$2.52
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: PHP Medicare Advantage |
$2.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.77
|
| Rate for Payer: Priority Health Medicare |
$2.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.87
|
| Rate for Payer: UHC Core |
$8.42
|
| Rate for Payer: UHC Exchange |
$2.52
|
| Rate for Payer: UHC Medicaid |
$1.78
|
| Rate for Payer: UHC Medicare Advantage |
$2.52
|
| Rate for Payer: UHCCP Medicaid |
$1.78
|
| Rate for Payer: VA VA |
$2.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.56
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.59
|
| Rate for Payer: BCN Commercial |
$23.59
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.42
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.13
|
| Rate for Payer: UHC Core |
$23.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
