|
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
|
IP
|
$14.86
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: BCBS Trust/PPO |
$12.13
|
| Rate for Payer: BCN Commercial |
$11.48
|
| 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: Healthscope Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health HMO/PPO |
$12.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.08
|
| Rate for Payer: UHC Core |
$12.41
|
| 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
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCN Commercial |
$11.94
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689002350
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCN Commercial |
$11.94
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$13.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.67
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health HMO/PPO |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.60
|
| Rate for Payer: UHC Core |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$7.58
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna Commercial |
$6.44
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.37
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$6.23
|
| Rate for Payer: BCN Commercial |
$5.89
|
| Rate for Payer: BCN Medicare Advantage |
$1.90
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.90
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.80
|
| Rate for Payer: PACE SWMI |
$1.90
|
| Rate for Payer: PHP Commercial |
$6.44
|
| Rate for Payer: PHP Medicare Advantage |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.93
|
| Rate for Payer: Priority Health HMO/PPO |
$6.59
|
| Rate for Payer: Priority Health Medicare |
$1.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$6.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.90
|
| Rate for Payer: UHC Medicare Advantage |
$1.90
|
| Rate for Payer: VA VA |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.68
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$530.25
|
|
|
Service Code
|
NDC 00904682661
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.93 |
| Max. Negotiated Rate |
$477.23 |
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.70
|
| Rate for Payer: BCBS Complete |
$212.10
|
| Rate for Payer: BCBS MAPPO |
$132.56
|
| Rate for Payer: BCBS Trust/PPO |
$435.92
|
| Rate for Payer: BCN Commercial |
$412.27
|
| Rate for Payer: BCN Medicare Advantage |
$132.56
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.56
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.71
|
| Rate for Payer: Nomi Health Commercial |
$434.81
|
| Rate for Payer: PACE Senior Care Partners |
$125.93
|
| Rate for Payer: PACE SWMI |
$132.56
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: PHP Medicare Advantage |
$132.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.66
|
| Rate for Payer: Priority Health HMO/PPO |
$461.32
|
| Rate for Payer: Priority Health Medicare |
$133.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.27
|
| Rate for Payer: Railroad Medicare Medicare |
$132.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.62
|
| Rate for Payer: UHC Core |
$442.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.56
|
| Rate for Payer: UHC Exchange |
$132.56
|
| Rate for Payer: UHC Medicare Advantage |
$132.56
|
| Rate for Payer: VA VA |
$132.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna Commercial |
$6.44
|
| Rate for Payer: BCBS Trust/PPO |
$6.19
|
| Rate for Payer: BCN Commercial |
$5.86
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PHP Commercial |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.93
|
| Rate for Payer: Priority Health HMO/PPO |
$6.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.68
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$530.25
|
|
|
Service Code
|
NDC 00904682661
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.66 |
| Max. Negotiated Rate |
$477.23 |
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: BCBS Trust/PPO |
$432.84
|
| Rate for Payer: BCN Commercial |
$409.78
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.71
|
| Rate for Payer: Nomi Health Commercial |
$434.81
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.66
|
| Rate for Payer: Priority Health HMO/PPO |
$461.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.62
|
| Rate for Payer: UHC Core |
$442.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$757.75
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.97 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Aetna Medicare |
$197.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$236.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$236.80
|
| Rate for Payer: BCBS Complete |
$303.10
|
| Rate for Payer: BCBS MAPPO |
$189.44
|
| Rate for Payer: BCBS Trust/PPO |
$622.95
|
| Rate for Payer: BCN Commercial |
$589.15
|
| Rate for Payer: BCN Medicare Advantage |
$189.44
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cofinity Commercial |
$651.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.44
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$217.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.09
|
| Rate for Payer: Nomi Health Commercial |
$621.36
|
| Rate for Payer: PACE Senior Care Partners |
$179.97
|
| Rate for Payer: PACE SWMI |
$189.44
|
| Rate for Payer: PHP Commercial |
$644.09
|
| Rate for Payer: PHP Medicare Advantage |
$189.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.54
|
| Rate for Payer: Priority Health HMO/PPO |
$659.24
|
| Rate for Payer: Priority Health Medicare |
$191.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.69
|
| Rate for Payer: Railroad Medicare Medicare |
$189.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.82
|
| Rate for Payer: UHC Core |
$632.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.44
|
| Rate for Payer: UHC Exchange |
$189.44
|
| Rate for Payer: UHC Medicare Advantage |
$189.44
|
| Rate for Payer: VA VA |
$189.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.31
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$757.75
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.54 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: BCBS Trust/PPO |
$618.55
|
| Rate for Payer: BCN Commercial |
$585.59
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cofinity Commercial |
$651.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.20
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.09
|
| Rate for Payer: Nomi Health Commercial |
$621.36
|
| Rate for Payer: PHP Commercial |
$644.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.54
|
| Rate for Payer: Priority Health HMO/PPO |
$659.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.82
|
| Rate for Payer: UHC Core |
$632.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.31
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
NDC 65162011510
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.81 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: BCBS Trust/PPO |
$278.56
|
| Rate for Payer: BCN Commercial |
$263.72
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health HMO/PPO |
$296.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.30
|
| Rate for Payer: UHC Core |
$284.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$204.75
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.63 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna Medicare |
$53.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.98
|
| Rate for Payer: BCBS Complete |
$81.90
|
| Rate for Payer: BCBS MAPPO |
$51.19
|
| Rate for Payer: BCBS Trust/PPO |
$168.32
|
| Rate for Payer: BCN Commercial |
$159.19
|
| Rate for Payer: BCN Medicare Advantage |
$51.19
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$176.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.19
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: Nomi Health Commercial |
$167.90
|
| Rate for Payer: PACE Senior Care Partners |
$48.63
|
| Rate for Payer: PACE SWMI |
$51.19
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: PHP Medicare Advantage |
$51.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health HMO/PPO |
$178.13
|
| Rate for Payer: Priority Health Medicare |
$51.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.18
|
| Rate for Payer: Railroad Medicare Medicare |
$51.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.18
|
| Rate for Payer: UHC Core |
$170.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.19
|
| Rate for Payer: UHC Exchange |
$51.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.19
|
| Rate for Payer: VA VA |
$51.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$204.75
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.09 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: BCBS Trust/PPO |
$167.14
|
| Rate for Payer: BCN Commercial |
$158.23
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$176.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: Nomi Health Commercial |
$167.90
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health HMO/PPO |
$178.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.18
|
| Rate for Payer: UHC Core |
$170.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
NDC 65162011510
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$88.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.64
|
| Rate for Payer: BCBS Complete |
$136.50
|
| Rate for Payer: BCBS MAPPO |
$85.31
|
| Rate for Payer: BCBS Trust/PPO |
$280.54
|
| Rate for Payer: BCN Commercial |
$265.32
|
| Rate for Payer: BCN Medicare Advantage |
$85.31
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.31
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Nomi Health Commercial |
$279.82
|
| Rate for Payer: PACE Senior Care Partners |
$81.05
|
| Rate for Payer: PACE SWMI |
$85.31
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: PHP Medicare Advantage |
$85.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health HMO/PPO |
$296.89
|
| Rate for Payer: Priority Health Medicare |
$86.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$228.64
|
| Rate for Payer: Railroad Medicare Medicare |
$85.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.30
|
| Rate for Payer: UHC Core |
$284.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.31
|
| Rate for Payer: UHC Exchange |
$85.31
|
| Rate for Payer: UHC Medicare Advantage |
$85.31
|
| Rate for Payer: VA VA |
$85.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$149.85
|
|
|
Service Code
|
NDC 68455010270
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$134.87 |
| Rate for Payer: Aetna Commercial |
$127.37
|
| Rate for Payer: Aetna Medicare |
$38.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.83
|
| Rate for Payer: BCBS Complete |
$59.94
|
| Rate for Payer: BCBS MAPPO |
$37.46
|
| Rate for Payer: BCBS Trust/PPO |
$123.19
|
| Rate for Payer: BCN Commercial |
$116.51
|
| Rate for Payer: BCN Medicare Advantage |
$37.46
|
| Rate for Payer: Cash Price |
$119.88
|
| Rate for Payer: Cofinity Commercial |
$128.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$134.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.37
|
| Rate for Payer: Nomi Health Commercial |
$122.88
|
| Rate for Payer: PACE Senior Care Partners |
$35.59
|
| Rate for Payer: PACE SWMI |
$37.46
|
| Rate for Payer: PHP Commercial |
$127.37
|
| Rate for Payer: PHP Medicare Advantage |
$37.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.40
|
| Rate for Payer: Priority Health HMO/PPO |
$130.37
|
| Rate for Payer: Priority Health Medicare |
$37.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.40
|
| Rate for Payer: Railroad Medicare Medicare |
$37.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.87
|
| Rate for Payer: UHC Core |
$125.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.46
|
| Rate for Payer: UHC Exchange |
$37.46
|
| Rate for Payer: UHC Medicare Advantage |
$37.46
|
| Rate for Payer: VA VA |
$37.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.39
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$149.85
|
|
|
Service Code
|
NDC 68455010270
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$134.87 |
| Rate for Payer: Aetna Commercial |
$127.37
|
| Rate for Payer: BCBS Trust/PPO |
$122.32
|
| Rate for Payer: BCN Commercial |
$115.80
|
| Rate for Payer: Cash Price |
$119.88
|
| Rate for Payer: Cofinity Commercial |
$128.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.88
|
| Rate for Payer: Healthscope Commercial |
$134.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.37
|
| Rate for Payer: Nomi Health Commercial |
$122.88
|
| Rate for Payer: PHP Commercial |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.40
|
| Rate for Payer: Priority Health HMO/PPO |
$130.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.87
|
| Rate for Payer: UHC Core |
$125.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.39
|
|
|
HYDROCOLLOID DRESSING 6" X 6"
|
Facility
|
OP
|
$68.55
|
|
|
Service Code
|
NDC 68455010271
|
| Hospital Charge Code |
111013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: Aetna Medicare |
$17.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.42
|
| Rate for Payer: BCBS Complete |
$27.42
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$56.35
|
| Rate for Payer: BCN Commercial |
$53.30
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$54.84
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.27
|
| Rate for Payer: Nomi Health Commercial |
$56.21
|
| Rate for Payer: PACE Senior Care Partners |
$16.28
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Commercial |
$58.27
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.56
|
| Rate for Payer: Priority Health HMO/PPO |
$59.64
|
| Rate for Payer: Priority Health Medicare |
$17.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.93
|
| Rate for Payer: Railroad Medicare Medicare |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.32
|
| Rate for Payer: UHC Core |
$57.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Exchange |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
| Rate for Payer: VA VA |
$17.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.41
|
|
|
HYDROCOLLOID DRESSING 6" X 6"
|
Facility
|
IP
|
$68.55
|
|
|
Service Code
|
NDC 68455010271
|
| Hospital Charge Code |
111013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| Rate for Payer: BCN Commercial |
$52.98
|
| Rate for Payer: Cash Price |
$54.84
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.84
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.27
|
| Rate for Payer: Nomi Health Commercial |
$56.21
|
| Rate for Payer: PHP Commercial |
$58.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.56
|
| Rate for Payer: Priority Health HMO/PPO |
$59.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.32
|
| Rate for Payer: UHC Core |
$57.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.41
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$650.88
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$423.07 |
| Max. Negotiated Rate |
$585.79 |
| Rate for Payer: Aetna Commercial |
$553.25
|
| Rate for Payer: BCBS Trust/PPO |
$531.31
|
| Rate for Payer: BCN Commercial |
$503.00
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$559.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Healthscope Commercial |
$585.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: Nomi Health Commercial |
$533.72
|
| Rate for Payer: PHP Commercial |
$553.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health HMO/PPO |
$566.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.77
|
| Rate for Payer: UHC Core |
$543.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.16
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$650.88
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.58 |
| Max. Negotiated Rate |
$585.79 |
| Rate for Payer: Aetna Commercial |
$553.25
|
| Rate for Payer: Aetna Medicare |
$169.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.40
|
| Rate for Payer: BCBS Complete |
$260.35
|
| Rate for Payer: BCBS MAPPO |
$162.72
|
| Rate for Payer: BCBS Trust/PPO |
$535.09
|
| Rate for Payer: BCN Commercial |
$506.06
|
| Rate for Payer: BCN Medicare Advantage |
$162.72
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$559.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.72
|
| Rate for Payer: Healthscope Commercial |
$585.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: Nomi Health Commercial |
$533.72
|
| Rate for Payer: PACE Senior Care Partners |
$154.58
|
| Rate for Payer: PACE SWMI |
$162.72
|
| Rate for Payer: PHP Commercial |
$553.25
|
| Rate for Payer: PHP Medicare Advantage |
$162.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health HMO/PPO |
$566.27
|
| Rate for Payer: Priority Health Medicare |
$164.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.09
|
| Rate for Payer: Railroad Medicare Medicare |
$162.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.77
|
| Rate for Payer: UHC Core |
$543.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.72
|
| Rate for Payer: UHC Exchange |
$162.72
|
| Rate for Payer: UHC Medicare Advantage |
$162.72
|
| Rate for Payer: VA VA |
$162.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.16
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$225.54
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$202.99 |
| Rate for Payer: Aetna Commercial |
$191.71
|
| Rate for Payer: BCBS Trust/PPO |
$184.11
|
| Rate for Payer: BCN Commercial |
$174.30
|
| Rate for Payer: Cash Price |
$180.43
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.43
|
| Rate for Payer: Healthscope Commercial |
$202.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.71
|
| Rate for Payer: Nomi Health Commercial |
$184.94
|
| Rate for Payer: PHP Commercial |
$191.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.60
|
| Rate for Payer: Priority Health HMO/PPO |
$196.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.48
|
| Rate for Payer: UHC Core |
$188.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.16
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$27.25
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.24
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Healthscope Commercial |
$24.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: PHP Commercial |
$23.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health HMO/PPO |
$23.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.98
|
| Rate for Payer: UHC Core |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$225.54
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$202.99 |
| Rate for Payer: Aetna Commercial |
$191.71
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.48
|
| Rate for Payer: BCBS Complete |
$90.22
|
| Rate for Payer: BCBS MAPPO |
$56.38
|
| Rate for Payer: BCBS Trust/PPO |
$185.42
|
| Rate for Payer: BCN Commercial |
$175.36
|
| Rate for Payer: BCN Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$180.43
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.38
|
| Rate for Payer: Healthscope Commercial |
$202.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.71
|
| Rate for Payer: Nomi Health Commercial |
$184.94
|
| Rate for Payer: PACE Senior Care Partners |
$53.57
|
| Rate for Payer: PACE SWMI |
$56.38
|
| Rate for Payer: PHP Commercial |
$191.71
|
| Rate for Payer: PHP Medicare Advantage |
$56.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.60
|
| Rate for Payer: Priority Health HMO/PPO |
$196.22
|
| Rate for Payer: Priority Health Medicare |
$56.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.11
|
| Rate for Payer: Railroad Medicare Medicare |
$56.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.48
|
| Rate for Payer: UHC Core |
$188.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.38
|
| Rate for Payer: UHC Exchange |
$56.38
|
| Rate for Payer: UHC Medicare Advantage |
$56.38
|
| Rate for Payer: VA VA |
$56.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.16
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$27.25
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.52
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS MAPPO |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$22.40
|
| Rate for Payer: BCN Commercial |
$21.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.81
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.81
|
| Rate for Payer: Healthscope Commercial |
$24.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: PACE Senior Care Partners |
$6.47
|
| Rate for Payer: PACE SWMI |
$6.81
|
| Rate for Payer: PHP Commercial |
$23.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health HMO/PPO |
$23.71
|
| Rate for Payer: Priority Health Medicare |
$6.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.98
|
| Rate for Payer: UHC Core |
$22.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.81
|
| Rate for Payer: UHC Exchange |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$6.81
|
| Rate for Payer: VA VA |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
