|
HYDROCHLORIC ACID (BULK) 37 % LIQUID
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
NDC 5155213206
|
| Hospital Charge Code |
10203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna American Axle |
$715.00
|
| Rate for Payer: Aetna Commercial |
$935.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.00
|
| Rate for Payer: BCBS Complete |
$440.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$770.00
|
| Rate for Payer: Cofinity Commercial |
$946.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$990.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$770.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health SBD |
$693.00
|
| Rate for Payer: UMR Bronson Commercial |
$407.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.00
|
|
|
HYDROCHLORIC ACID (BULK) 37 % LIQUID
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
NDC 5155213206
|
| Hospital Charge Code |
10203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$484.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Aetna American Axle |
$715.00
|
| Rate for Payer: Aetna Commercial |
$935.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cofinity Commercial |
$770.00
|
| Rate for Payer: Cofinity Commercial |
$946.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$880.00
|
| Rate for Payer: Healthscope Commercial |
$990.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$770.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$825.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.00
|
| Rate for Payer: Priority Health SBD |
$693.00
|
| Rate for Payer: UMR Bronson Commercial |
$484.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$825.00
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 51079-776-01
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.16
|
| Rate for Payer: Priority Health SBD |
$1.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 29300-130-01
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.92 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.76
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.28
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 51079-776-20
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna American Axle |
$200.10
|
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.10
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.67
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.50
|
| Rate for Payer: Priority Health SBD |
$193.95
|
| Rate for Payer: UMR Bronson Commercial |
$135.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 50228-146-01
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$282.15
|
|
|
Service Code
|
NDC 0172-4870-00
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: Aetna American Axle |
$183.40
|
| Rate for Payer: Aetna Commercial |
$239.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.40
|
| Rate for Payer: Cash Price |
$225.72
|
| Rate for Payer: Cofinity Commercial |
$197.50
|
| Rate for Payer: Cofinity Commercial |
$242.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.72
|
| Rate for Payer: Healthscope Commercial |
$253.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$197.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$211.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.83
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.50
|
| Rate for Payer: Priority Health SBD |
$177.75
|
| Rate for Payer: UMR Bronson Commercial |
$124.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.61
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 29300-128-01
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.51
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$30.55
|
|
|
Service Code
|
NDC 16729-183-01
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna American Axle |
$19.86
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.86
|
| Rate for Payer: Cash Price |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$26.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$27.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.97
|
| Rate for Payer: PHP Commercial |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.38
|
| Rate for Payer: Priority Health SBD |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$13.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.91
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 60687-593-11
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 60687-593-01
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.32 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$208.92
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.68
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.92
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UMR Bronson Commercial |
$131.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$58.75
|
|
|
Service Code
|
NDC 63739-128-10
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.88 |
| Rate for Payer: Aetna American Axle |
$38.19
|
| Rate for Payer: Aetna Commercial |
$49.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.19
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$52.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.94
|
| Rate for Payer: PHP Commercial |
$49.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 0904-6825-61
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$480.20
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$583.10
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$480.20
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UMR Bronson Commercial |
$301.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$81.03
|
|
|
Service Code
|
NDC 0406-0125-62
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna American Axle |
$52.67
|
| Rate for Payer: Aetna Commercial |
$68.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.67
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$56.72
|
| Rate for Payer: Cofinity Commercial |
$69.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Healthscope Commercial |
$72.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.88
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.72
|
| Rate for Payer: Priority Health SBD |
$51.05
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.77
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
NDC 27808-037-01
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.11
|
|
|
Service Code
|
NDC 0406-0125-23
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Aetna American Axle |
$5.27
|
| Rate for Payer: Aetna Commercial |
$6.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.27
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cofinity Commercial |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$7.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.89
|
| Rate for Payer: PHP Commercial |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.68
|
| Rate for Payer: Priority Health SBD |
$5.11
|
| Rate for Payer: UMR Bronson Commercial |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.08
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,034.25
|
|
|
Service Code
|
NDC 60687-418-01
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$455.07 |
| Max. Negotiated Rate |
$930.82 |
| Rate for Payer: Aetna American Axle |
$672.26
|
| Rate for Payer: Aetna Commercial |
$879.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$672.26
|
| Rate for Payer: Cash Price |
$827.40
|
| Rate for Payer: Cofinity Commercial |
$723.98
|
| Rate for Payer: Cofinity Commercial |
$889.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$827.40
|
| Rate for Payer: Healthscope Commercial |
$930.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$723.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$775.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$879.11
|
| Rate for Payer: PHP Commercial |
$879.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$723.98
|
| Rate for Payer: Priority Health SBD |
$651.58
|
| Rate for Payer: UMR Bronson Commercial |
$455.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$775.69
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
NDC 60687-418-11
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna American Axle |
$6.73
|
| Rate for Payer: Aetna Commercial |
$8.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.73
|
| Rate for Payer: Cash Price |
$8.28
|
| Rate for Payer: Cofinity Commercial |
$7.24
|
| Rate for Payer: Cofinity Commercial |
$8.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.28
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.80
|
| Rate for Payer: PHP Commercial |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.24
|
| Rate for Payer: Priority Health SBD |
$6.52
|
| Rate for Payer: UMR Bronson Commercial |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.76
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$236.25
|
|
|
Service Code
|
NDC 53746-110-01
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$212.62 |
| Rate for Payer: Aetna American Axle |
$153.56
|
| Rate for Payer: Aetna Commercial |
$200.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cofinity Commercial |
$165.38
|
| Rate for Payer: Cofinity Commercial |
$203.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.00
|
| Rate for Payer: Healthscope Commercial |
$212.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.81
|
| Rate for Payer: PHP Commercial |
$200.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.38
|
| Rate for Payer: Priority Health SBD |
$148.84
|
| Rate for Payer: UMR Bronson Commercial |
$103.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.19
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$306.60
|
|
|
Service Code
|
NDC 68084-895-09
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$275.94 |
| Rate for Payer: Aetna American Axle |
$199.29
|
| Rate for Payer: Aetna Commercial |
$260.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.29
|
| Rate for Payer: Cash Price |
$245.28
|
| Rate for Payer: Cofinity Commercial |
$214.62
|
| Rate for Payer: Cofinity Commercial |
$263.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.28
|
| Rate for Payer: Healthscope Commercial |
$275.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.61
|
| Rate for Payer: PHP Commercial |
$260.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.62
|
| Rate for Payer: Priority Health SBD |
$193.16
|
| Rate for Payer: UMR Bronson Commercial |
$134.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.95
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$69.13
|
|
|
Service Code
|
NDC 0406-0123-62
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna American Axle |
$44.93
|
| Rate for Payer: Aetna Commercial |
$58.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.93
|
| Rate for Payer: Cash Price |
$55.30
|
| Rate for Payer: Cofinity Commercial |
$48.39
|
| Rate for Payer: Cofinity Commercial |
$59.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.30
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.76
|
| Rate for Payer: PHP Commercial |
$58.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.39
|
| Rate for Payer: Priority Health SBD |
$43.55
|
| Rate for Payer: UMR Bronson Commercial |
$30.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.85
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 57664-126-88
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$388.50
|
|
|
Service Code
|
NDC 0904-6824-61
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna American Axle |
$252.52
|
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.52
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cofinity Commercial |
$271.95
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$271.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.22
|
| Rate for Payer: PHP Commercial |
$330.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.95
|
| Rate for Payer: Priority Health SBD |
$244.76
|
| Rate for Payer: UMR Bronson Commercial |
$170.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.38
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 68084-895-11
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$6.04
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$6.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.34
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.92
|
|
|
Service Code
|
NDC 0406-0123-23
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$6.23 |
| Rate for Payer: Aetna American Axle |
$4.50
|
| Rate for Payer: Aetna Commercial |
$5.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.50
|
| Rate for Payer: Cash Price |
$5.54
|
| Rate for Payer: Cofinity Commercial |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.54
|
| Rate for Payer: Healthscope Commercial |
$6.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.88
|
| Rate for Payer: PHP Commercial |
$5.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.84
|
| Rate for Payer: Priority Health SBD |
$4.36
|
| Rate for Payer: UMR Bronson Commercial |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.19
|
|
