|
HYDROCHLORIC ACID 0.1 N LOCK SOLUTION
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 09900001127
|
| Hospital Charge Code |
300175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Advantage |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
HYDROCHLORIC ACID (BULK) 37 % LIQUID
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
NDC 51552132006
|
| 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 Medicare |
$550.00
|
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$880.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$935.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$825.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| Rate for Payer: Priority Health SBD |
$693.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$715.00
|
| Rate for Payer: UHC Core |
$573.10
|
| Rate for Payer: UHC Exchange |
$432.30
|
| 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 51552132006
|
| 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 Advantage |
$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 Commercial |
$935.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$825.00
|
| Rate for Payer: PHP Commercial |
$935.00
|
| 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
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 29300013001
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.16 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UMR Bronson Commercial |
$96.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$282.15
|
|
|
Service Code
|
NDC 00172487000
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$253.94 |
| Rate for Payer: Aetna American Axle |
$183.40
|
| Rate for Payer: Aetna Commercial |
$239.83
|
| Rate for Payer: Aetna Medicare |
$141.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.40
|
| Rate for Payer: BCBS Complete |
$112.86
|
| Rate for Payer: Cash Price |
$225.72
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$225.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.61
|
| Rate for Payer: PHP Commercial |
$239.83
|
| Rate for Payer: Priority Health SBD |
$177.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.40
|
| Rate for Payer: UHC Core |
$147.00
|
| Rate for Payer: UHC Exchange |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$104.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$211.61
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$282.15
|
|
|
Service Code
|
NDC 00172487000
|
| 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 Advantage |
$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 Commercial |
$239.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.61
|
| Rate for Payer: PHP Commercial |
$239.83
|
| 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 12.5 MG CAPSULE
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 29300013001
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna American Axle |
$142.06
|
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$109.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Advantage |
$152.99
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health SBD |
$137.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.06
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Exchange |
$85.89
|
| Rate for Payer: UMR Bronson Commercial |
$80.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$49.35
|
|
|
Service Code
|
NDC 69584036110
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna Medicare |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: BCBS Complete |
$19.74
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.08
|
| Rate for Payer: UHC Core |
$25.71
|
| Rate for Payer: UHC Exchange |
$19.39
|
| Rate for Payer: UMR Bronson Commercial |
$18.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.28
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Exchange |
$9.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$86.95
|
|
|
Service Code
|
NDC 29300012801
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna American Axle |
$56.52
|
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Advantage |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| Rate for Payer: UMR Bronson Commercial |
$38.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.29
|
| Rate for Payer: UHC Core |
$1.04
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Advantage |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$198.55
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.46 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$99.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Advantage |
$138.99
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.06
|
| Rate for Payer: UHC Core |
$103.44
|
| Rate for Payer: UHC Exchange |
$78.03
|
| Rate for Payer: UMR Bronson Commercial |
$73.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$49.35
|
|
|
Service Code
|
NDC 69584036110
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: Aetna American Axle |
$32.08
|
| Rate for Payer: Aetna Commercial |
$41.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.08
|
| Rate for Payer: Cash Price |
$39.48
|
| Rate for Payer: Cofinity Advantage |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.48
|
| Rate for Payer: Healthscope Commercial |
$44.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.01
|
| Rate for Payer: PHP Commercial |
$41.95
|
| Rate for Payer: Priority Health SBD |
$31.09
|
| Rate for Payer: UMR Bronson Commercial |
$21.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.01
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Advantage |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$86.95
|
|
|
Service Code
|
NDC 29300012801
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.17 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna American Axle |
$56.52
|
| Rate for Payer: Aetna Commercial |
$73.91
|
| Rate for Payer: Aetna Medicare |
$43.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.52
|
| Rate for Payer: BCBS Complete |
$34.78
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Advantage |
$60.87
|
| Rate for Payer: Cofinity Commercial |
$74.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$78.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: PHP Commercial |
$73.91
|
| Rate for Payer: Priority Health SBD |
$54.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.52
|
| Rate for Payer: UHC Core |
$45.30
|
| Rate for Payer: UHC Exchange |
$34.17
|
| Rate for Payer: UMR Bronson Commercial |
$32.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.21
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$346.50
|
|
|
Service Code
|
NDC 27808003701
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$311.85 |
| Rate for Payer: Aetna American Axle |
$225.22
|
| Rate for Payer: Aetna Commercial |
$294.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.22
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cofinity Advantage |
$242.55
|
| Rate for Payer: Cofinity Commercial |
$297.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.20
|
| Rate for Payer: Healthscope Commercial |
$311.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.88
|
| Rate for Payer: PHP Commercial |
$294.52
|
| Rate for Payer: Priority Health SBD |
$218.29
|
| Rate for Payer: UMR Bronson Commercial |
$152.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.88
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$10.49
|
|
|
Service Code
|
NDC 60687041811
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.62 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: Cash Price |
$8.39
|
| Rate for Payer: Cofinity Advantage |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$9.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: Priority Health SBD |
$6.61
|
| Rate for Payer: UMR Bronson Commercial |
$4.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.87
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
NDC 00904682561
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$548.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$514.50
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.90
|
| Rate for Payer: UHC Core |
$357.41
|
| Rate for Payer: UHC Exchange |
$269.60
|
| Rate for Payer: UMR Bronson Commercial |
$253.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$290.50
|
|
|
Service Code
|
NDC 53746011001
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: Cash Price |
$232.40
|
| Rate for Payer: Cofinity Advantage |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.40
|
| Rate for Payer: Healthscope Commercial |
$261.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.88
|
| Rate for Payer: PHP Commercial |
$246.93
|
| Rate for Payer: Priority Health SBD |
$183.01
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$10.49
|
|
|
Service Code
|
NDC 60687041811
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Aetna American Axle |
$6.82
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.82
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: Cash Price |
$8.39
|
| Rate for Payer: Cofinity Advantage |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$9.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.87
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: Priority Health SBD |
$6.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.82
|
| Rate for Payer: UHC Core |
$5.47
|
| Rate for Payer: UHC Exchange |
$4.12
|
| Rate for Payer: UMR Bronson Commercial |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.87
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$46.06
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$41.45 |
| Rate for Payer: Aetna American Axle |
$29.94
|
| Rate for Payer: Aetna Commercial |
$39.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.94
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cofinity Advantage |
$32.24
|
| Rate for Payer: Cofinity Commercial |
$39.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$41.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.55
|
| Rate for Payer: PHP Commercial |
$39.15
|
| Rate for Payer: Priority Health SBD |
$29.02
|
| Rate for Payer: UMR Bronson Commercial |
$20.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.55
|
|
