|
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 |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| 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 |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| 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 |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| 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 |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
|
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
|
$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 |
$222.42
|
| 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
|
|
|
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
|
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
|
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 |
$70.52
|
| 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 |
$222.42
|
| 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
|
OP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.08 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Medicare |
$20.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.10
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS MAPPO |
$20.08
|
| Rate for Payer: BCBS Trust/PPO |
$66.04
|
| Rate for Payer: BCN Commercial |
$62.46
|
| Rate for Payer: BCN Medicare Advantage |
$20.08
|
| 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: Health Alliance Plan Medicare Advantage |
$20.08
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: PACE Senior Care Partners |
$19.08
|
| Rate for Payer: PACE SWMI |
$20.08
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: PHP Medicare Advantage |
$20.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health HMO/PPO |
$69.89
|
| Rate for Payer: Priority Health Medicare |
$20.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.82
|
| Rate for Payer: Railroad Medicare Medicare |
$20.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.69
|
| Rate for Payer: UHC Core |
$67.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.08
|
| Rate for Payer: UHC Exchange |
$20.08
|
| Rate for Payer: UHC Medicare Advantage |
$20.08
|
| Rate for Payer: VA VA |
$20.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
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 |
$162.92 |
| 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 |
$533.36
|
| 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 |
$180.08
|
| 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 |
$162.92
|
| 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
|
OP
|
$5.43
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$4.89 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.70
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS MAPPO |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.22
|
| Rate for Payer: BCN Medicare Advantage |
$1.36
|
| 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: Health Alliance Plan Medicare Advantage |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$4.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.62
|
| Rate for Payer: Nomi Health Commercial |
$4.45
|
| Rate for Payer: PACE Senior Care Partners |
$1.29
|
| Rate for Payer: PACE SWMI |
$1.36
|
| Rate for Payer: PHP Commercial |
$4.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health HMO/PPO |
$4.72
|
| Rate for Payer: Priority Health Medicare |
$1.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.78
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.36
|
| Rate for Payer: UHC Exchange |
$1.36
|
| Rate for Payer: UHC Medicare Advantage |
$1.36
|
| Rate for Payer: VA VA |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.07
|
|
|
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 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 |
$204.90 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: Aetna Medicare |
$224.32
|
| 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 |
$345.10
|
| Rate for Payer: BCBS MAPPO |
$215.69
|
| Rate for Payer: BCBS Trust/PPO |
$709.27
|
| Rate for Payer: BCN Commercial |
$670.79
|
| Rate for Payer: BCN Medicare Advantage |
$215.69
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$741.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| 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 Cigna Priority Health |
$560.79
|
| Rate for Payer: Priority Health HMO/PPO |
$750.59
|
| Rate for Payer: Priority Health Medicare |
$217.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.04
|
| 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 Dual Complete DSNP |
$215.69
|
| Rate for Payer: UHC Exchange |
$215.69
|
| Rate for Payer: UHC Medicare Advantage |
$215.69
|
| 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
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.04
|
| Rate for Payer: BCN Commercial |
$6.67
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.59
|
| Rate for Payer: UHC Core |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$54.14
|
| Rate for Payer: BCBS Trust/PPO |
$52.00
|
| Rate for Payer: BCN Commercial |
$49.23
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.14
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: PHP Commercial |
$54.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.40
|
| Rate for Payer: Priority Health HMO/PPO |
$55.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.06
|
| Rate for Payer: UHC Core |
$53.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.78
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
NDC 10702018950
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$374.06 |
| Max. Negotiated Rate |
$1,417.50 |
| Rate for Payer: Aetna Commercial |
$1,338.75
|
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$492.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$492.19
|
| Rate for Payer: BCBS Complete |
$630.00
|
| Rate for Payer: BCBS MAPPO |
$393.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,294.81
|
| Rate for Payer: BCN Commercial |
$1,224.56
|
| Rate for Payer: BCN Medicare Advantage |
$393.75
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cofinity Commercial |
$1,354.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,260.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.75
|
| Rate for Payer: Healthscope Commercial |
$1,417.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,181.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,338.75
|
| Rate for Payer: Nomi Health Commercial |
$1,291.50
|
| Rate for Payer: PACE Senior Care Partners |
$374.06
|
| Rate for Payer: PACE SWMI |
$393.75
|
| Rate for Payer: PHP Commercial |
$1,338.75
|
| Rate for Payer: PHP Medicare Advantage |
$393.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,370.25
|
| Rate for Payer: Priority Health Medicare |
$397.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,055.25
|
| Rate for Payer: Railroad Medicare Medicare |
$393.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,386.00
|
| Rate for Payer: UHC Core |
$1,315.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.75
|
| Rate for Payer: UHC Exchange |
$393.75
|
| Rate for Payer: UHC Medicare Advantage |
$393.75
|
| Rate for Payer: VA VA |
$393.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,181.25
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.20
|
| Rate for Payer: BCN Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health HMO/PPO |
$5.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
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 |
$2.05 |
| 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 |
$3.45
|
| Rate for Payer: BCBS MAPPO |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$6.71
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| 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 Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health HMO/PPO |
$7.51
|
| Rate for Payer: Priority Health Medicare |
$2.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.78
|
| 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 Dual Complete DSNP |
$2.16
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UHC Medicare Advantage |
$2.16
|
| 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
|
$862.75
|
|
|
Service Code
|
NDC 68084089501
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.79 |
| Max. Negotiated Rate |
$776.48 |
| Rate for Payer: Aetna Commercial |
$733.34
|
| Rate for Payer: BCBS Trust/PPO |
$704.26
|
| Rate for Payer: BCN Commercial |
$666.73
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$741.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| Rate for Payer: PHP Commercial |
$733.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.79
|
| Rate for Payer: Priority Health HMO/PPO |
$750.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.22
|
| Rate for Payer: UHC Core |
$720.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$647.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
NDC 10702018950
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,023.75 |
| Max. Negotiated Rate |
$1,417.50 |
| Rate for Payer: Aetna Commercial |
$1,338.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.67
|
| Rate for Payer: BCN Commercial |
$1,217.16
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cofinity Commercial |
$1,354.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,260.00
|
| Rate for Payer: Healthscope Commercial |
$1,417.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,181.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,338.75
|
| Rate for Payer: Nomi Health Commercial |
$1,291.50
|
| Rate for Payer: PHP Commercial |
$1,338.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,370.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,055.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,386.00
|
| Rate for Payer: UHC Core |
$1,315.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,181.25
|
|
|
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 |
$92.27 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna Commercial |
$330.22
|
| 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 |
$155.40
|
| Rate for Payer: BCBS MAPPO |
$97.12
|
| Rate for Payer: BCBS Trust/PPO |
$319.39
|
| Rate for Payer: BCN Commercial |
$302.06
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.22
|
| Rate for Payer: Nomi Health Commercial |
$318.57
|
| Rate for Payer: PACE Senior Care Partners |
$92.27
|
| Rate for Payer: PACE SWMI |
$97.12
|
| Rate for Payer: PHP Commercial |
$330.22
|
| Rate for Payer: PHP Medicare Advantage |
$97.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.52
|
| Rate for Payer: Priority Health HMO/PPO |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$98.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.30
|
| 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 Dual Complete DSNP |
$97.12
|
| Rate for Payer: UHC Exchange |
$97.12
|
| Rate for Payer: UHC Medicare Advantage |
$97.12
|
| 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
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$1.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$2.55
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$4.95
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health HMO/PPO |
$5.54
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.27
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$5.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.59
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$54.14
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.91
|
| Rate for Payer: BCBS Complete |
$25.48
|
| Rate for Payer: BCBS MAPPO |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$52.37
|
| Rate for Payer: BCN Commercial |
$49.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.14
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: PACE Senior Care Partners |
$15.13
|
| Rate for Payer: PACE SWMI |
$15.92
|
| Rate for Payer: PHP Commercial |
$54.14
|
| Rate for Payer: PHP Medicare Advantage |
$15.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.40
|
| Rate for Payer: Priority Health HMO/PPO |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.68
|
| Rate for Payer: Railroad Medicare Medicare |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.06
|
| Rate for Payer: UHC Core |
$53.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.92
|
| Rate for Payer: UHC Exchange |
$15.92
|
| Rate for Payer: UHC Medicare Advantage |
$15.92
|
| Rate for Payer: VA VA |
$15.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.78
|
|
|
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 |
$252.52 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: BCBS Trust/PPO |
$317.13
|
| Rate for Payer: BCN Commercial |
$300.23
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.80
|
| Rate for Payer: Healthscope Commercial |
$349.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.22
|
| Rate for Payer: Nomi Health Commercial |
$318.57
|
| Rate for Payer: PHP Commercial |
$330.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.52
|
| Rate for Payer: Priority Health HMO/PPO |
$338.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.30
|
| 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 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 |
$13.68 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$17.17
|
| Rate for Payer: BCN Commercial |
$16.26
|
| 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: 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: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.68
|
| Rate for Payer: Priority Health HMO/PPO |
$18.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.10
|
| 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
|
IP
|
$16.38
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: BCBS Trust/PPO |
$13.37
|
| Rate for Payer: BCN Commercial |
$12.66
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: Nomi Health Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health HMO/PPO |
$14.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Core |
$13.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.28
|
|
