|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$290.50
|
|
|
Service Code
|
NDC 53746011001
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.93
|
| Rate for Payer: Aetna Medicare |
$145.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: BCBS Complete |
$116.20
|
| 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: MI Amish Medical Board Commercial |
$232.40
|
| 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: UHC All Payor (Choice/PPO) |
$188.82
|
| Rate for Payer: UHC Core |
$151.35
|
| Rate for Payer: UHC Exchange |
$114.17
|
| Rate for Payer: UMR Bronson Commercial |
$107.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$346.50
|
|
|
Service Code
|
NDC 27808003701
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.21 |
| Max. Negotiated Rate |
$311.85 |
| Rate for Payer: Aetna American Axle |
$225.22
|
| Rate for Payer: Aetna Commercial |
$294.52
|
| Rate for Payer: Aetna Medicare |
$173.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.22
|
| Rate for Payer: BCBS Complete |
$138.60
|
| 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: MI Amish Medical Board Commercial |
$277.20
|
| 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: UHC All Payor (Choice/PPO) |
$225.22
|
| Rate for Payer: UHC Core |
$180.53
|
| Rate for Payer: UHC Exchange |
$136.17
|
| Rate for Payer: UMR Bronson Commercial |
$128.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.88
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$1,048.25
|
|
|
Service Code
|
NDC 60687041801
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.85 |
| Max. Negotiated Rate |
$943.42 |
| Rate for Payer: Aetna American Axle |
$681.36
|
| Rate for Payer: Aetna Commercial |
$891.01
|
| Rate for Payer: Aetna Medicare |
$524.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.36
|
| Rate for Payer: BCBS Complete |
$419.30
|
| Rate for Payer: Cash Price |
$838.60
|
| Rate for Payer: Cofinity Advantage |
$733.77
|
| Rate for Payer: Cofinity Commercial |
$901.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.60
|
| Rate for Payer: Healthscope Commercial |
$943.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$838.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$891.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$786.19
|
| Rate for Payer: PHP Commercial |
$891.01
|
| Rate for Payer: Priority Health SBD |
$660.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.36
|
| Rate for Payer: UHC Core |
$546.14
|
| Rate for Payer: UHC Exchange |
$411.96
|
| Rate for Payer: UMR Bronson Commercial |
$387.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.19
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 00406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 00904682561
|
| 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 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: 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: 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
|
$1,048.25
|
|
|
Service Code
|
NDC 60687041801
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.23 |
| Max. Negotiated Rate |
$943.42 |
| Rate for Payer: Aetna American Axle |
$681.36
|
| Rate for Payer: Aetna Commercial |
$891.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.36
|
| Rate for Payer: Cash Price |
$838.60
|
| Rate for Payer: Cofinity Advantage |
$733.77
|
| Rate for Payer: Cofinity Commercial |
$901.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$838.60
|
| Rate for Payer: Healthscope Commercial |
$943.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$733.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$786.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$891.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$786.19
|
| Rate for Payer: PHP Commercial |
$891.01
|
| Rate for Payer: Priority Health SBD |
$660.40
|
| Rate for Payer: UMR Bronson Commercial |
$461.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$786.19
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 00406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$46.06
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$41.45 |
| Rate for Payer: Aetna American Axle |
$29.94
|
| Rate for Payer: Aetna Commercial |
$39.15
|
| Rate for Payer: Aetna Medicare |
$23.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.94
|
| Rate for Payer: BCBS Complete |
$18.42
|
| 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: MI Amish Medical Board Commercial |
$36.85
|
| 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: UHC All Payor (Choice/PPO) |
$29.94
|
| Rate for Payer: UHC Core |
$24.00
|
| Rate for Payer: UHC Exchange |
$18.10
|
| Rate for Payer: UMR Bronson Commercial |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.55
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$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 Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| 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
|
$238.00
|
|
|
Service Code
|
NDC 53746010901
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna American Axle |
$154.70
|
| Rate for Payer: Aetna Commercial |
$202.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.70
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Advantage |
$166.60
|
| Rate for Payer: Cofinity Commercial |
$204.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.40
|
| Rate for Payer: Healthscope Commercial |
$214.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.50
|
| Rate for Payer: PHP Commercial |
$202.30
|
| Rate for Payer: Priority Health SBD |
$149.94
|
| Rate for Payer: UMR Bronson Commercial |
$104.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.50
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$388.50
|
|
|
Service Code
|
NDC 00904682461
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna American Axle |
$252.53
|
| Rate for Payer: Aetna Commercial |
$330.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.53
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$330.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.38
|
| Rate for Payer: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health SBD |
$244.75
|
| 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
|
$325.50
|
|
|
Service Code
|
NDC 00406012301
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UMR Bronson Commercial |
$143.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
NDC 00406012301
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Medicare |
$162.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: BCBS Complete |
$130.20
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.57
|
| Rate for Payer: UHC Core |
$169.59
|
| Rate for Payer: UHC Exchange |
$127.92
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$7.46
|
|
|
Service Code
|
NDC 60687039611
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna American Axle |
$4.85
|
| Rate for Payer: Aetna Commercial |
$6.34
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.85
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cofinity Advantage |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.97
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.59
|
| Rate for Payer: PHP Commercial |
$6.34
|
| Rate for Payer: Priority Health SBD |
$4.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: UHC Exchange |
$2.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.59
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$306.60
|
|
|
Service Code
|
NDC 68084089509
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.44 |
| Max. Negotiated Rate |
$275.94 |
| Rate for Payer: Aetna American Axle |
$199.29
|
| Rate for Payer: Aetna Commercial |
$260.61
|
| Rate for Payer: Aetna Medicare |
$153.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.29
|
| Rate for Payer: BCBS Complete |
$122.64
|
| Rate for Payer: Cash Price |
$245.28
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$245.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.95
|
| Rate for Payer: PHP Commercial |
$260.61
|
| Rate for Payer: Priority Health SBD |
$193.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.29
|
| Rate for Payer: UHC Core |
$159.74
|
| Rate for Payer: UHC Exchange |
$120.49
|
| Rate for Payer: UMR Bronson Commercial |
$113.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.95
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$1,592.50
|
|
|
Service Code
|
NDC 53746010905
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.23 |
| Max. Negotiated Rate |
$1,433.25 |
| Rate for Payer: Aetna American Axle |
$1,035.12
|
| Rate for Payer: Aetna Commercial |
$1,353.62
|
| Rate for Payer: Aetna Medicare |
$796.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.12
|
| Rate for Payer: BCBS Complete |
$637.00
|
| Rate for Payer: Cash Price |
$1,274.00
|
| Rate for Payer: Cofinity Advantage |
$1,114.75
|
| Rate for Payer: Cofinity Commercial |
$1,369.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,274.00
|
| Rate for Payer: Healthscope Commercial |
$1,433.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,114.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,194.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,274.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,353.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,194.38
|
| Rate for Payer: PHP Commercial |
$1,353.62
|
| Rate for Payer: Priority Health SBD |
$1,003.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,035.12
|
| Rate for Payer: UHC Core |
$829.69
|
| Rate for Payer: UHC Exchange |
$625.85
|
| Rate for Payer: UMR Bronson Commercial |
$589.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,194.38
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$4.50
|
| Rate for Payer: UHC Exchange |
$3.39
|
| Rate for Payer: UMR Bronson Commercial |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$745.50
|
|
|
Service Code
|
NDC 60687039601
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.83 |
| Max. Negotiated Rate |
$670.95 |
| Rate for Payer: Aetna American Axle |
$484.57
|
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Medicare |
$372.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.57
|
| Rate for Payer: BCBS Complete |
$298.20
|
| Rate for Payer: Cash Price |
$596.40
|
| Rate for Payer: Cofinity Advantage |
$521.85
|
| Rate for Payer: Cofinity Commercial |
$641.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$596.40
|
| Rate for Payer: Healthscope Commercial |
$670.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$521.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$559.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$596.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$559.12
|
| Rate for Payer: PHP Commercial |
$633.67
|
| Rate for Payer: Priority Health SBD |
$469.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.57
|
| Rate for Payer: UHC Core |
$388.41
|
| Rate for Payer: UHC Exchange |
$292.98
|
| Rate for Payer: UMR Bronson Commercial |
$275.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$559.12
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$306.60
|
|
|
Service Code
|
NDC 68084089509
|
| 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 Advantage |
$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 Commercial |
$260.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.95
|
| Rate for Payer: PHP Commercial |
$260.61
|
| 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
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna American Axle |
$5.61
|
| Rate for Payer: Aetna Commercial |
$7.34
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.61
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Core |
$4.50
|
| Rate for Payer: UHC Exchange |
$3.39
|
| Rate for Payer: UMR Bronson Commercial |
$3.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$86.28
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.96 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna American Axle |
$56.08
|
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Advantage |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: UMR Bronson Commercial |
$37.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$388.50
|
|
|
Service Code
|
NDC 00904682461
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.75 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna American Axle |
$252.53
|
| Rate for Payer: Aetna Commercial |
$330.23
|
| Rate for Payer: Aetna Medicare |
$194.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.53
|
| Rate for Payer: BCBS Complete |
$155.40
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$310.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.38
|
| Rate for Payer: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health SBD |
$244.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.53
|
| Rate for Payer: UHC Core |
$202.41
|
| Rate for Payer: UHC Exchange |
$152.68
|
| Rate for Payer: UMR Bronson Commercial |
$143.75
|
| 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 00406012323
|
| 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 Advantage |
$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 Commercial |
$7.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: PHP Commercial |
$7.34
|
| 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
|
$7.46
|
|
|
Service Code
|
NDC 60687039611
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna American Axle |
$4.85
|
| Rate for Payer: Aetna Commercial |
$6.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.85
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cofinity Advantage |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.97
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.59
|
| Rate for Payer: PHP Commercial |
$6.34
|
| Rate for Payer: Priority Health SBD |
$4.70
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.59
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$86.28
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$77.65 |
| Rate for Payer: Aetna American Axle |
$56.08
|
| Rate for Payer: Aetna Commercial |
$73.34
|
| Rate for Payer: Aetna Medicare |
$43.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.08
|
| Rate for Payer: BCBS Complete |
$34.51
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Advantage |
$60.40
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$77.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: PHP Commercial |
$73.34
|
| Rate for Payer: Priority Health SBD |
$54.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.08
|
| Rate for Payer: UHC Core |
$44.95
|
| Rate for Payer: UHC Exchange |
$33.91
|
| Rate for Payer: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.71
|
|
