|
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
|
$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 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 |
$252.53 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna Commercial |
$330.23
|
| 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 |
$330.23
|
| Rate for Payer: Nomi Health Commercial |
$318.57
|
| Rate for Payer: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.53
|
| 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 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 |
$41.41 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| 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 |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| 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 |
$47.77
|
|
|
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
|
$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
|
$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
|
$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 |
$330.23
|
| Rate for Payer: Aetna Medicare |
$101.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.41
|
| Rate for Payer: BCBS Complete |
$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 |
$330.23
|
| 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 |
$330.23
|
| Rate for Payer: PHP Medicare Advantage |
$97.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.53
|
| 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
|
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 |
$741.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| Rate for Payer: 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
|
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 |
$54.15
|
| 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 |
$15.93
|
| Rate for Payer: BCBS Trust/PPO |
$52.37
|
| Rate for Payer: BCN Commercial |
$49.53
|
| Rate for Payer: BCN Medicare Advantage |
$15.93
|
| 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 |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| 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 |
$54.15
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: PACE Senior Care Partners |
$15.13
|
| Rate for Payer: PACE SWMI |
$15.93
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: PHP Medicare Advantage |
$15.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| 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 |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.06
|
| Rate for Payer: UHC Core |
$53.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.93
|
| Rate for Payer: UHC Exchange |
$15.93
|
| Rate for Payer: UHC Medicare Advantage |
$15.93
|
| Rate for Payer: VA VA |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
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 |
$224.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$269.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$269.61
|
| Rate for Payer: BCBS Complete |
$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 |
$741.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.69
|
| Rate for Payer: Healthscope Commercial |
$776.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$647.06
|
| Rate for Payer: 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
|
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 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$10.13
|
|
|
Service Code
|
NDC 09900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.27
|
| Rate for Payer: BCN Commercial |
$7.83
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$8.31
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: Priority Health HMO/PPO |
$8.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.64
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS MAPPO |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCN Commercial |
$11.55
|
| Rate for Payer: BCN Medicare Advantage |
$3.71
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: PACE Senior Care Partners |
$3.53
|
| Rate for Payer: PACE SWMI |
$3.71
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health HMO/PPO |
$12.93
|
| Rate for Payer: Priority Health Medicare |
$3.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.08
|
| Rate for Payer: UHC Core |
$12.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.71
|
| Rate for Payer: UHC Exchange |
$3.71
|
| Rate for Payer: UHC Medicare Advantage |
$3.71
|
| Rate for Payer: VA VA |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
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
|
$40.11
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: BCBS Trust/PPO |
$32.74
|
| Rate for Payer: BCN Commercial |
$31.00
|
| 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: PHP Commercial |
$34.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.07
|
| Rate for Payer: Priority Health HMO/PPO |
$34.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.87
|
| 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/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna Medicare |
$4.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.12
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: BCBS MAPPO |
$4.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.47
|
| Rate for Payer: BCN Commercial |
$12.74
|
| Rate for Payer: BCN Medicare Advantage |
$4.09
|
| 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: Health Alliance Plan Medicare Advantage |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: Nomi Health Commercial |
$13.43
|
| Rate for Payer: PACE Senior Care Partners |
$3.89
|
| Rate for Payer: PACE SWMI |
$4.09
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: PHP Medicare Advantage |
$4.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health HMO/PPO |
$14.25
|
| Rate for Payer: Priority Health Medicare |
$4.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.97
|
| Rate for Payer: Railroad Medicare Medicare |
$4.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Core |
$13.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.09
|
| Rate for Payer: UHC Exchange |
$4.09
|
| Rate for Payer: UHC Medicare Advantage |
$4.09
|
| Rate for Payer: VA VA |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
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 |
$12.29
|
| 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 |
$12.29
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$10.13
|
|
|
Service Code
|
NDC 09900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$2.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.17
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS MAPPO |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$8.33
|
| Rate for Payer: BCN Commercial |
$7.88
|
| Rate for Payer: BCN Medicare Advantage |
$2.53
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Nomi Health Commercial |
$8.31
|
| Rate for Payer: PACE Senior Care Partners |
$2.41
|
| Rate for Payer: PACE SWMI |
$2.53
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: Priority Health HMO/PPO |
$8.81
|
| Rate for Payer: Priority Health Medicare |
$2.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.53
|
| Rate for Payer: UHC Exchange |
$2.53
|
| Rate for Payer: UHC Medicare Advantage |
$2.53
|
| Rate for Payer: VA VA |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$40.11
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$36.10 |
| Rate for Payer: Aetna Commercial |
$34.09
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.53
|
| Rate for Payer: BCBS Complete |
$16.04
|
| Rate for Payer: BCBS MAPPO |
$10.03
|
| Rate for Payer: BCBS Trust/PPO |
$32.97
|
| Rate for Payer: BCN Commercial |
$31.19
|
| Rate for Payer: BCN Medicare Advantage |
$10.03
|
| Rate for Payer: Cash Price |
$32.09
|
| Rate for Payer: Cofinity Commercial |
$34.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.03
|
| Rate for Payer: Healthscope Commercial |
$36.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.09
|
| Rate for Payer: Nomi Health Commercial |
$32.89
|
| Rate for Payer: PACE Senior Care Partners |
$9.53
|
| Rate for Payer: PACE SWMI |
$10.03
|
| Rate for Payer: PHP Commercial |
$34.09
|
| Rate for Payer: PHP Medicare Advantage |
$10.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.07
|
| Rate for Payer: Priority Health HMO/PPO |
$34.90
|
| Rate for Payer: Priority Health Medicare |
$10.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.87
|
| Rate for Payer: Railroad Medicare Medicare |
$10.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.30
|
| Rate for Payer: UHC Core |
$33.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.03
|
| Rate for Payer: UHC Exchange |
$10.03
|
| Rate for Payer: UHC Medicare Advantage |
$10.03
|
| Rate for Payer: VA VA |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.08
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.83
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: BCBS MAPPO |
$3.86
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Medicare Advantage |
$3.86
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.86
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: PACE Senior Care Partners |
$3.67
|
| Rate for Payer: PACE SWMI |
$3.86
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: PHP Medicare Advantage |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Medicare |
$3.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.86
|
| Rate for Payer: UHC Exchange |
$3.86
|
| Rate for Payer: UHC Medicare Advantage |
$3.86
|
| Rate for Payer: VA VA |
$3.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.64
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS MAPPO |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$12.22
|
| Rate for Payer: BCN Commercial |
$11.55
|
| Rate for Payer: BCN Medicare Advantage |
$3.71
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: PACE Senior Care Partners |
$3.53
|
| Rate for Payer: PACE SWMI |
$3.71
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health HMO/PPO |
$12.93
|
| Rate for Payer: Priority Health Medicare |
$3.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.08
|
| Rate for Payer: UHC Core |
$12.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.71
|
| Rate for Payer: UHC Exchange |
$3.71
|
| Rate for Payer: UHC Medicare Advantage |
$3.71
|
| Rate for Payer: VA VA |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
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 |
$5.00 |
| 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 |
$8.42
|
| Rate for Payer: BCBS MAPPO |
$5.26
|
| Rate for Payer: BCBS Trust/PPO |
$17.30
|
| Rate for Payer: BCN Commercial |
$16.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: Nomi Health Commercial |
$17.25
|
| 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 Cigna Priority Health |
$13.68
|
| Rate for Payer: Priority Health HMO/PPO |
$18.30
|
| Rate for Payer: Priority Health Medicare |
$5.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.10
|
| 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 Dual Complete DSNP |
$5.26
|
| Rate for Payer: UHC Exchange |
$5.26
|
| Rate for Payer: UHC Medicare Advantage |
$5.26
|
| Rate for Payer: VA VA |
$5.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.78
|
|
