|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$883.75
|
|
|
Service Code
|
NDC 53746-109-05
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.85 |
| Max. Negotiated Rate |
$795.38 |
| Rate for Payer: Aetna American Axle |
$574.44
|
| Rate for Payer: Aetna Commercial |
$751.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.44
|
| Rate for Payer: Cash Price |
$707.00
|
| Rate for Payer: Cofinity Commercial |
$618.62
|
| Rate for Payer: Cofinity Commercial |
$760.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$707.00
|
| Rate for Payer: Healthscope Commercial |
$795.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$618.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$662.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$751.19
|
| Rate for Payer: PHP Commercial |
$751.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.62
|
| Rate for Payer: Priority Health SBD |
$556.76
|
| Rate for Payer: UMR Bronson Commercial |
$388.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$662.81
|
|
|
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 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.91
|
|
|
Service Code
|
NDC 0121-2316-15
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.37
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689-023-01
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna American Axle |
$10.04
|
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.13
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| Rate for Payer: UMR Bronson Commercial |
$6.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$92.10
|
|
|
Service Code
|
NDC 0121-0772-16
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.52 |
| Max. Negotiated Rate |
$82.89 |
| Rate for Payer: Aetna American Axle |
$59.86
|
| Rate for Payer: Aetna Commercial |
$78.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.86
|
| Rate for Payer: Cash Price |
$73.68
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.68
|
| Rate for Payer: Healthscope Commercial |
$82.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.28
|
| Rate for Payer: PHP Commercial |
$78.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.47
|
| Rate for Payer: Priority Health SBD |
$58.02
|
| Rate for Payer: UMR Bronson Commercial |
$40.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.08
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$12.76
|
|
|
Service Code
|
NDC 60687-417-71
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna American Axle |
$8.29
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.85
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.93
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.57
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$12.76
|
|
|
Service Code
|
NDC 60687-417-44
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna American Axle |
$8.29
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.85
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.93
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.57
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.91
|
|
|
Service Code
|
NDC 0121-2316-50
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$15.22 |
| Rate for Payer: Aetna American Axle |
$10.99
|
| Rate for Payer: Aetna Commercial |
$14.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.99
|
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$14.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.37
|
| Rate for Payer: PHP Commercial |
$14.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health SBD |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$7.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.68
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689-023-50
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna American Axle |
$10.04
|
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$10.82
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.13
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.82
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| Rate for Payer: UMR Bronson Commercial |
$6.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$530.25
|
|
|
Service Code
|
NDC 0904-6826-61
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$477.22 |
| Rate for Payer: Aetna American Axle |
$344.66
|
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.66
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Commercial |
$371.18
|
| Rate for Payer: Cofinity Commercial |
$456.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Healthscope Commercial |
$477.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$450.71
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.18
|
| Rate for Payer: Priority Health SBD |
$334.06
|
| Rate for Payer: UMR Bronson Commercial |
$233.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.23
|
|
|
Service Code
|
NDC 0406-0124-23
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Aetna American Axle |
$5.35
|
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.35
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Commercial |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$7.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.00
|
| Rate for Payer: PHP Commercial |
$7.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.76
|
| Rate for Payer: Priority Health SBD |
$5.18
|
| Rate for Payer: UMR Bronson Commercial |
$3.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.17
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$3,412.50
|
|
|
Service Code
|
NDC 0406-0124-10
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,501.50 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna American Axle |
$2,218.12
|
| Rate for Payer: Aetna Commercial |
$2,900.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,218.12
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Cofinity Commercial |
$2,388.75
|
| Rate for Payer: Cofinity Commercial |
$2,934.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,730.00
|
| Rate for Payer: Healthscope Commercial |
$3,071.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,388.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,559.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,900.62
|
| Rate for Payer: PHP Commercial |
$2,900.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,388.75
|
| Rate for Payer: Priority Health SBD |
$2,149.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,501.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,559.38
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
NDC 27808-036-01
|
| Hospital Charge Code |
34544
|
|
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 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$822.50
|
|
|
Service Code
|
NDC 0406-0124-62
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.90 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Aetna American Axle |
$534.62
|
| Rate for Payer: Aetna Commercial |
$699.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.62
|
| Rate for Payer: Cash Price |
$658.00
|
| Rate for Payer: Cofinity Commercial |
$575.75
|
| Rate for Payer: Cofinity Commercial |
$707.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$658.00
|
| Rate for Payer: Healthscope Commercial |
$740.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$575.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$699.12
|
| Rate for Payer: PHP Commercial |
$699.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.75
|
| Rate for Payer: Priority Health SBD |
$518.18
|
| Rate for Payer: UMR Bronson Commercial |
$361.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.88
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
NDC 60687-407-11
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna American Axle |
$4.93
|
| Rate for Payer: Aetna Commercial |
$6.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.93
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$5.31
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$5.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.44
|
| Rate for Payer: PHP Commercial |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.31
|
| Rate for Payer: Priority Health SBD |
$4.78
|
| Rate for Payer: UMR Bronson Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.68
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
NDC 65162-115-10
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna American Axle |
$221.81
|
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.81
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Commercial |
$238.88
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$238.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$290.06
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health SBD |
$214.99
|
| Rate for Payer: UMR Bronson Commercial |
$150.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$204.75
|
|
|
Service Code
|
NDC 71930-020-12
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.32
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$90.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$5.94
|
|
|
Service Code
|
NDC 51079-778-01
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna American Axle |
$3.86
|
| Rate for Payer: Aetna Commercial |
$5.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.86
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cofinity Commercial |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$5.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.75
|
| Rate for Payer: Healthscope Commercial |
$5.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.46
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$757.75
|
|
|
Service Code
|
NDC 60687-407-01
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.41 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna American Axle |
$492.54
|
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.54
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cofinity Commercial |
$530.42
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$530.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$644.09
|
| Rate for Payer: PHP Commercial |
$644.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.42
|
| Rate for Payer: Priority Health SBD |
$477.38
|
| Rate for Payer: UMR Bronson Commercial |
$333.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.31
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 0603-3891-21
|
| Hospital Charge Code |
34544
|
|
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 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,732.50
|
|
|
Service Code
|
NDC 65162-115-11
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$762.30 |
| Max. Negotiated Rate |
$1,559.25 |
| Rate for Payer: Aetna American Axle |
$1,126.12
|
| Rate for Payer: Aetna Commercial |
$1,472.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,126.12
|
| Rate for Payer: Cash Price |
$1,386.00
|
| Rate for Payer: Cofinity Commercial |
$1,212.75
|
| Rate for Payer: Cofinity Commercial |
$1,489.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,386.00
|
| Rate for Payer: Healthscope Commercial |
$1,559.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,212.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,299.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,472.62
|
| Rate for Payer: PHP Commercial |
$1,472.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,212.75
|
| Rate for Payer: Priority Health SBD |
$1,091.48
|
| Rate for Payer: UMR Bronson Commercial |
$762.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,299.38
|
|
|
HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$620.82
|
|
|
Service Code
|
NDC 50383-043-16
|
| Hospital Charge Code |
3724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.16 |
| Max. Negotiated Rate |
$558.74 |
| Rate for Payer: Aetna American Axle |
$403.53
|
| Rate for Payer: Aetna Commercial |
$527.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.53
|
| Rate for Payer: Cash Price |
$496.66
|
| Rate for Payer: Cofinity Commercial |
$434.57
|
| Rate for Payer: Cofinity Commercial |
$533.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$558.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$527.70
|
| Rate for Payer: PHP Commercial |
$527.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.57
|
| Rate for Payer: Priority Health SBD |
$391.12
|
| Rate for Payer: UMR Bronson Commercial |
$273.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.62
|
|
|
HYDROCODONE-HOMATROPINE 5 MG-1.5 MG TABLET
|
Facility
|
IP
|
$1,044.75
|
|
|
Service Code
|
NDC 43386-118-01
|
| Hospital Charge Code |
10204
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$459.69 |
| Max. Negotiated Rate |
$940.28 |
| Rate for Payer: Aetna American Axle |
$679.09
|
| Rate for Payer: Aetna Commercial |
$888.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.09
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cofinity Commercial |
$731.32
|
| Rate for Payer: Cofinity Commercial |
$898.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$835.80
|
| Rate for Payer: Healthscope Commercial |
$940.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$731.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$783.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$888.04
|
| Rate for Payer: PHP Commercial |
$888.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.32
|
| Rate for Payer: Priority Health SBD |
$658.19
|
| Rate for Payer: UMR Bronson Commercial |
$459.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$783.56
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 6845510691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.86
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
NDC 6845510697
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.19
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.42
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
