|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$171.85 |
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: Aetna Medicare |
$49.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.67
|
| Rate for Payer: BCBS Complete |
$76.38
|
| Rate for Payer: BCBS MAPPO |
$47.74
|
| Rate for Payer: BCBS Trust/PPO |
$156.98
|
| Rate for Payer: BCN Commercial |
$148.46
|
| Rate for Payer: BCN Medicare Advantage |
$47.74
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.74
|
| Rate for Payer: Healthscope Commercial |
$171.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Nomi Health Commercial |
$156.58
|
| Rate for Payer: PACE Senior Care Partners |
$45.35
|
| Rate for Payer: PACE SWMI |
$47.74
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: PHP Medicare Advantage |
$47.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: Priority Health HMO/PPO |
$166.13
|
| Rate for Payer: Priority Health Medicare |
$48.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.94
|
| Rate for Payer: Railroad Medicare Medicare |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.04
|
| Rate for Payer: UHC Core |
$159.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.74
|
| Rate for Payer: UHC Exchange |
$47.74
|
| Rate for Payer: UHC Medicare Advantage |
$47.74
|
| Rate for Payer: VA VA |
$47.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.57
|
| Rate for Payer: BCN Commercial |
$1.49
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1.66
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.68
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.03 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: BCBS Trust/PPO |
$211.01
|
| Rate for Payer: BCN Commercial |
$199.77
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.03
|
| Rate for Payer: Priority Health HMO/PPO |
$224.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.19
|
| 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
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$171.85 |
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: BCBS Trust/PPO |
$155.87
|
| Rate for Payer: BCN Commercial |
$147.57
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$171.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Nomi Health Commercial |
$156.58
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: Priority Health HMO/PPO |
$166.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.04
|
| Rate for Payer: UHC Core |
$159.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: BCBS Trust/PPO |
$67.14
|
| Rate for Payer: BCN Commercial |
$63.56
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health HMO/PPO |
$71.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$15.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.09
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: BCBS MAPPO |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$47.51
|
| Rate for Payer: BCN Medicare Advantage |
$15.28
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PACE Senior Care Partners |
$14.51
|
| Rate for Payer: PACE SWMI |
$15.28
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: PHP Medicare Advantage |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Medicare |
$15.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: Railroad Medicare Medicare |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.28
|
| Rate for Payer: UHC Exchange |
$15.28
|
| Rate for Payer: UHC Medicare Advantage |
$15.28
|
| Rate for Payer: VA VA |
$15.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
NDC 51079077601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: PACE Senior Care Partners |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO |
$2.68
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.06
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.71
|
| Rate for Payer: UHC Core |
$2.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.77
|
| Rate for Payer: UHC Exchange |
$0.77
|
| Rate for Payer: UHC Medicare Advantage |
$0.77
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: BCBS Trust/PPO |
$49.88
|
| Rate for Payer: BCN Commercial |
$47.22
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.83
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$307.85
|
|
|
Service Code
|
NDC 51079077620
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: Aetna Medicare |
$80.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.20
|
| Rate for Payer: BCBS Complete |
$123.14
|
| Rate for Payer: BCBS MAPPO |
$76.96
|
| Rate for Payer: BCBS Trust/PPO |
$253.08
|
| Rate for Payer: BCN Commercial |
$239.35
|
| Rate for Payer: BCN Medicare Advantage |
$76.96
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.96
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Nomi Health Commercial |
$252.44
|
| Rate for Payer: PACE Senior Care Partners |
$73.11
|
| Rate for Payer: PACE SWMI |
$76.96
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: PHP Medicare Advantage |
$76.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.10
|
| Rate for Payer: Priority Health HMO/PPO |
$267.83
|
| Rate for Payer: Priority Health Medicare |
$77.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.26
|
| Rate for Payer: Railroad Medicare Medicare |
$76.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.96
|
| Rate for Payer: UHC Exchange |
$76.96
|
| Rate for Payer: UHC Medicare Advantage |
$76.96
|
| Rate for Payer: VA VA |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 51079077620
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: BCBS Trust/PPO |
$251.30
|
| Rate for Payer: BCN Commercial |
$237.91
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Nomi Health Commercial |
$252.44
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.10
|
| Rate for Payer: Priority Health HMO/PPO |
$267.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 51079077601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.71
|
| Rate for Payer: UHC Core |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| 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 |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$18.27
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| 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 Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| 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 Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.09
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.81 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$113.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.59
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS MAPPO |
$109.28
|
| Rate for Payer: BCBS Trust/PPO |
$359.34
|
| Rate for Payer: BCN Commercial |
$339.85
|
| Rate for Payer: BCN Medicare Advantage |
$109.28
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.28
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: PACE Senior Care Partners |
$103.81
|
| Rate for Payer: PACE SWMI |
$109.28
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: PHP Medicare Advantage |
$109.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO |
$380.28
|
| Rate for Payer: Priority Health Medicare |
$110.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: Railroad Medicare Medicare |
$109.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.28
|
| Rate for Payer: UHC Exchange |
$109.28
|
| Rate for Payer: UHC Medicare Advantage |
$109.28
|
| Rate for Payer: VA VA |
$109.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$18.16
|
| 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| 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
|
$437.10
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: BCBS Trust/PPO |
$356.80
|
| Rate for Payer: BCN Commercial |
$337.79
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO |
$380.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$4.38
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.29
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: Aetna Medicare |
$70.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.77
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: BCBS MAPPO |
$67.81
|
| Rate for Payer: BCBS Trust/PPO |
$222.99
|
| Rate for Payer: BCN Commercial |
$210.90
|
| Rate for Payer: BCN Medicare Advantage |
$67.81
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.81
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.43
|
| Rate for Payer: PACE Senior Care Partners |
$64.42
|
| Rate for Payer: PACE SWMI |
$67.81
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: PHP Medicare Advantage |
$67.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health HMO/PPO |
$235.99
|
| Rate for Payer: Priority Health Medicare |
$68.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.74
|
| Rate for Payer: Railroad Medicare Medicare |
$67.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.70
|
| Rate for Payer: UHC Core |
$226.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.81
|
| Rate for Payer: UHC Exchange |
$67.81
|
| Rate for Payer: UHC Medicare Advantage |
$67.81
|
| Rate for Payer: VA VA |
$67.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$5.43
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: BCBS Trust/PPO |
$4.43
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$4.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$4.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.62
|
| Rate for Payer: Nomi Health Commercial |
$4.45
|
| Rate for Payer: PHP Commercial |
$4.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health HMO/PPO |
$4.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.78
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.07
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: BCBS Trust/PPO |
$65.57
|
| Rate for Payer: BCN Commercial |
$62.08
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health HMO/PPO |
$69.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.69
|
| Rate for Payer: UHC Core |
$67.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.04
|
|
|
Service Code
|
NDC 00406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.51
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS MAPPO |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$6.61
|
| Rate for Payer: BCN Commercial |
$6.25
|
| Rate for Payer: BCN Medicare Advantage |
$2.01
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.01
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.83
|
| Rate for Payer: Nomi Health Commercial |
$6.59
|
| Rate for Payer: PACE Senior Care Partners |
$1.91
|
| Rate for Payer: PACE SWMI |
$2.01
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: PHP Medicare Advantage |
$2.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health HMO/PPO |
$6.99
|
| Rate for Payer: Priority Health Medicare |
$2.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.39
|
| Rate for Payer: Railroad Medicare Medicare |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.01
|
| Rate for Payer: UHC Exchange |
$2.01
|
| Rate for Payer: UHC Medicare Advantage |
$2.01
|
| Rate for Payer: VA VA |
$2.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.03
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.04
|
|
|
Service Code
|
NDC 00406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Aetna Commercial |
$6.83
|
| Rate for Payer: BCBS Trust/PPO |
$6.56
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$6.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.43
|
| Rate for Payer: Healthscope Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.83
|
| Rate for Payer: Nomi Health Commercial |
$6.59
|
| Rate for Payer: PHP Commercial |
$6.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.23
|
| Rate for Payer: Priority Health HMO/PPO |
$6.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.08
|
| Rate for Payer: UHC Core |
$6.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.03
|
|
|
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 |
$162.93 |
| 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 |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$171.50
|
| Rate for Payer: BCBS Trust/PPO |
$563.96
|
| Rate for Payer: BCN Commercial |
$533.37
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$197.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| 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 Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO |
$596.82
|
| Rate for Payer: Priority Health Medicare |
$173.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$459.62
|
| 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 Dual Complete DSNP |
$171.50
|
| Rate for Payer: UHC Exchange |
$171.50
|
| Rate for Payer: UHC Medicare Advantage |
$171.50
|
| 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
|
$686.00
|
|
|
Service Code
|
NDC 00904682561
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: BCBS Trust/PPO |
$559.98
|
| Rate for Payer: BCN Commercial |
$530.14
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Nomi Health Commercial |
$562.52
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO |
$596.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$459.62
|
| 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
|
$271.25
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$244.12 |
| Rate for Payer: Aetna Commercial |
$230.56
|
| Rate for Payer: BCBS Trust/PPO |
$221.42
|
| Rate for Payer: BCN Commercial |
$209.62
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$233.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$244.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.43
|
| Rate for Payer: PHP Commercial |
$230.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health HMO/PPO |
$235.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.70
|
| Rate for Payer: UHC Core |
$226.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.44
|
|
