|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$745.50
|
|
|
Service Code
|
NDC 60687039601
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.02 |
| Max. Negotiated Rate |
$670.95 |
| Rate for Payer: Aetna American Axle |
$484.57
|
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.57
|
| 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: 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: UMR Bronson Commercial |
$328.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$559.12
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
NDC 53746010901
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna American Axle |
$154.70
|
| Rate for Payer: Aetna Commercial |
$202.30
|
| Rate for Payer: Aetna Medicare |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.70
|
| Rate for Payer: BCBS Complete |
$95.20
|
| 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: MI Amish Medical Board Commercial |
$190.40
|
| 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: UHC All Payor (Choice/PPO) |
$154.70
|
| Rate for Payer: UHC Core |
$124.00
|
| Rate for Payer: UHC Exchange |
$93.53
|
| Rate for Payer: UMR Bronson Commercial |
$88.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.50
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,592.50
|
|
|
Service Code
|
NDC 53746010905
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$700.70 |
| 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 New Business (MI Preferred) |
$1,035.12
|
| 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: 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: UMR Bronson Commercial |
$700.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,194.38
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$17.96
|
|
|
Service Code
|
NDC 00121231650
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna American Axle |
$11.67
|
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Medicare |
$8.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Advantage |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Core |
$9.36
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$85.85
|
|
|
Service Code
|
NDC 00121077216
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$77.27 |
| Rate for Payer: Aetna American Axle |
$55.80
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: UMR Bronson Commercial |
$37.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$17.96
|
|
|
Service Code
|
NDC 00121231650
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna American Axle |
$11.67
|
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Advantage |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$8.51
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689002350
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$10.81
|
| 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 |
$10.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| 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
|
OP
|
$479.20
|
|
|
Service Code
|
NDC 64950034316
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.30 |
| Max. Negotiated Rate |
$431.28 |
| Rate for Payer: Aetna American Axle |
$311.48
|
| Rate for Payer: Aetna Commercial |
$407.32
|
| Rate for Payer: Aetna Medicare |
$239.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.48
|
| Rate for Payer: BCBS Complete |
$191.68
|
| Rate for Payer: Cash Price |
$383.36
|
| Rate for Payer: Cofinity Advantage |
$335.44
|
| Rate for Payer: Cofinity Commercial |
$412.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.36
|
| Rate for Payer: Healthscope Commercial |
$431.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.40
|
| Rate for Payer: PHP Commercial |
$407.32
|
| Rate for Payer: Priority Health SBD |
$301.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.48
|
| Rate for Payer: UHC Core |
$249.66
|
| Rate for Payer: UHC Exchange |
$188.33
|
| Rate for Payer: UMR Bronson Commercial |
$177.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.40
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$566.61
|
|
|
Service Code
|
NDC 71930002743
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.65 |
| Max. Negotiated Rate |
$509.95 |
| Rate for Payer: Aetna American Axle |
$368.30
|
| Rate for Payer: Aetna Commercial |
$481.62
|
| Rate for Payer: Aetna Medicare |
$283.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.30
|
| Rate for Payer: BCBS Complete |
$226.64
|
| Rate for Payer: Cash Price |
$453.29
|
| Rate for Payer: Cofinity Advantage |
$396.63
|
| Rate for Payer: Cofinity Commercial |
$487.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.29
|
| Rate for Payer: Healthscope Commercial |
$509.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$424.96
|
| Rate for Payer: PHP Commercial |
$481.62
|
| Rate for Payer: Priority Health SBD |
$356.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.30
|
| Rate for Payer: UHC Core |
$295.20
|
| Rate for Payer: UHC Exchange |
$222.68
|
| Rate for Payer: UMR Bronson Commercial |
$209.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.96
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$85.85
|
|
|
Service Code
|
NDC 00121077216
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$77.27 |
| Rate for Payer: Aetna American Axle |
$55.80
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: BCBS Complete |
$34.34
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.80
|
| Rate for Payer: UHC Core |
$44.73
|
| Rate for Payer: UHC Exchange |
$33.74
|
| Rate for Payer: UMR Bronson Commercial |
$31.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.39
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna American Axle |
$10.04
|
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Advantage |
$10.81
|
| 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 |
$10.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.04
|
| Rate for Payer: UHC Core |
$8.05
|
| Rate for Payer: UHC Exchange |
$6.07
|
| Rate for Payer: UMR Bronson Commercial |
$5.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$566.61
|
|
|
Service Code
|
NDC 71930002743
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.31 |
| Max. Negotiated Rate |
$509.95 |
| Rate for Payer: Aetna American Axle |
$368.30
|
| Rate for Payer: Aetna Commercial |
$481.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.30
|
| Rate for Payer: Cash Price |
$453.29
|
| Rate for Payer: Cofinity Advantage |
$396.63
|
| Rate for Payer: Cofinity Commercial |
$487.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.29
|
| Rate for Payer: Healthscope Commercial |
$509.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$424.96
|
| Rate for Payer: PHP Commercial |
$481.62
|
| Rate for Payer: Priority Health SBD |
$356.96
|
| Rate for Payer: UMR Bronson Commercial |
$249.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.96
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.33
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$479.20
|
|
|
Service Code
|
NDC 64950034316
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.85 |
| Max. Negotiated Rate |
$431.28 |
| Rate for Payer: Aetna American Axle |
$311.48
|
| Rate for Payer: Aetna Commercial |
$407.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.48
|
| Rate for Payer: Cash Price |
$383.36
|
| Rate for Payer: Cofinity Advantage |
$335.44
|
| Rate for Payer: Cofinity Commercial |
$412.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.36
|
| Rate for Payer: Healthscope Commercial |
$431.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$335.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.40
|
| Rate for Payer: PHP Commercial |
$407.32
|
| Rate for Payer: Priority Health SBD |
$301.90
|
| Rate for Payer: UMR Bronson Commercial |
$210.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.40
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$17.96
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna American Axle |
$11.67
|
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Advantage |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.45
|
|
|
Service Code
|
NDC 66689002350
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$13.90 |
| Rate for Payer: Aetna American Axle |
$10.04
|
| Rate for Payer: Aetna Commercial |
$13.13
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Advantage |
$10.81
|
| 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 |
$10.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.04
|
| Rate for Payer: UHC Core |
$8.05
|
| Rate for Payer: UHC Exchange |
$6.07
|
| Rate for Payer: UMR Bronson Commercial |
$5.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.33
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$17.96
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$16.16 |
| Rate for Payer: Aetna American Axle |
$11.67
|
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Medicare |
$8.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cofinity Advantage |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$15.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.37
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.47
|
| Rate for Payer: PHP Commercial |
$15.27
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.67
|
| Rate for Payer: UHC Core |
$9.36
|
| Rate for Payer: UHC Exchange |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.47
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.33
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna American Axle |
$10.61
|
| Rate for Payer: Aetna Commercial |
$13.88
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Advantage |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.25
|
| Rate for Payer: PHP Commercial |
$13.88
|
| Rate for Payer: Priority Health SBD |
$10.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.61
|
| Rate for Payer: UHC Core |
$8.51
|
| Rate for Payer: UHC Exchange |
$6.42
|
| Rate for Payer: UMR Bronson Commercial |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.45
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$10.81
|
| 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 |
$10.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.59
|
| Rate for Payer: PHP Commercial |
$13.13
|
| 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
|
OP
|
$5.94
|
|
|
Service Code
|
NDC 51079077801
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$5.35 |
| Rate for Payer: Aetna American Axle |
$3.86
|
| Rate for Payer: Aetna Commercial |
$5.05
|
| Rate for Payer: Aetna Medicare |
$2.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.86
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: Cash Price |
$4.75
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$4.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.46
|
| Rate for Payer: PHP Commercial |
$5.05
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.86
|
| Rate for Payer: UHC Core |
$3.09
|
| Rate for Payer: UHC Exchange |
$2.33
|
| Rate for Payer: UMR Bronson Commercial |
$2.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.46
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Aetna American Axle |
$6.44
|
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.44
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cofinity Advantage |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.93
|
| Rate for Payer: Healthscope Commercial |
$8.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.43
|
| Rate for Payer: PHP Commercial |
$8.42
|
| Rate for Payer: Priority Health SBD |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.44
|
| Rate for Payer: UHC Core |
$5.16
|
| Rate for Payer: UHC Exchange |
$3.89
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.43
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$537.25
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.78 |
| Max. Negotiated Rate |
$483.52 |
| Rate for Payer: Aetna American Axle |
$349.21
|
| Rate for Payer: Aetna Commercial |
$456.66
|
| Rate for Payer: Aetna Medicare |
$268.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.21
|
| Rate for Payer: BCBS Complete |
$214.90
|
| Rate for Payer: Cash Price |
$429.80
|
| Rate for Payer: Cofinity Advantage |
$376.07
|
| Rate for Payer: Cofinity Commercial |
$462.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$429.80
|
| Rate for Payer: Healthscope Commercial |
$483.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$402.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.94
|
| Rate for Payer: PHP Commercial |
$456.66
|
| Rate for Payer: Priority Health SBD |
$338.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.21
|
| Rate for Payer: UHC Core |
$279.91
|
| Rate for Payer: UHC Exchange |
$211.14
|
| Rate for Payer: UMR Bronson Commercial |
$198.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$5.94
|
|
|
Service Code
|
NDC 51079077801
|
| 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 Advantage |
$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 Commercial |
$5.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.46
|
| Rate for Payer: PHP Commercial |
$5.05
|
| 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
|
|
