|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.82
|
|
|
Service Code
|
NDC 60687040711
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna American Axle |
$5.73
|
| Rate for Payer: Aetna Commercial |
$7.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.73
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Advantage |
$6.17
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$7.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.62
|
| Rate for Payer: PHP Commercial |
$7.50
|
| Rate for Payer: Priority Health SBD |
$5.56
|
| Rate for Payer: UMR Bronson Commercial |
$3.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
NDC 60687040701
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna American Axle |
$573.30
|
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Medicare |
$441.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.30
|
| Rate for Payer: BCBS Complete |
$352.80
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Advantage |
$617.40
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$705.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.50
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: Priority Health SBD |
$555.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.30
|
| Rate for Payer: UHC Core |
$459.52
|
| Rate for Payer: UHC Exchange |
$346.63
|
| Rate for Payer: UMR Bronson Commercial |
$326.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$3,412.50
|
|
|
Service Code
|
NDC 00406012410
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,501.50 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna American Axle |
$2,218.12
|
| Rate for Payer: Aetna Commercial |
$2,900.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,218.12
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Cofinity Advantage |
$2,388.75
|
| Rate for Payer: Cofinity Commercial |
$2,934.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,730.00
|
| Rate for Payer: Healthscope Commercial |
$3,071.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,388.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,559.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,900.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,559.38
|
| Rate for Payer: PHP Commercial |
$2,900.62
|
| Rate for Payer: Priority Health SBD |
$2,149.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,501.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,559.38
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$537.25
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.39 |
| Max. Negotiated Rate |
$483.52 |
| Rate for Payer: Aetna American Axle |
$349.21
|
| Rate for Payer: Aetna Commercial |
$456.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.21
|
| 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: 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: UMR Bronson Commercial |
$236.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$402.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$3,412.50
|
|
|
Service Code
|
NDC 00406012410
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,262.62 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna American Axle |
$2,218.12
|
| Rate for Payer: Aetna Commercial |
$2,900.62
|
| Rate for Payer: Aetna Medicare |
$1,706.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,218.12
|
| Rate for Payer: BCBS Complete |
$1,365.00
|
| Rate for Payer: Cash Price |
$2,730.00
|
| Rate for Payer: Cofinity Advantage |
$2,388.75
|
| Rate for Payer: Cofinity Commercial |
$2,934.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,730.00
|
| Rate for Payer: Healthscope Commercial |
$3,071.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,388.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,559.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,730.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,900.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,559.38
|
| Rate for Payer: PHP Commercial |
$2,900.62
|
| Rate for Payer: Priority Health SBD |
$2,149.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,218.12
|
| Rate for Payer: UHC Core |
$1,777.91
|
| Rate for Payer: UHC Exchange |
$1,341.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,262.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,559.38
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$530.25
|
|
|
Service Code
|
NDC 00904682661
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.31 |
| Max. Negotiated Rate |
$477.23 |
| Rate for Payer: Aetna American Axle |
$344.66
|
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.66
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Advantage |
$371.18
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.69
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: Priority Health SBD |
$334.06
|
| Rate for Payer: UMR Bronson Commercial |
$233.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$990.50
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$435.82 |
| Max. Negotiated Rate |
$891.45 |
| Rate for Payer: Aetna American Axle |
$643.83
|
| Rate for Payer: Aetna Commercial |
$841.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.83
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: Cofinity Advantage |
$693.35
|
| Rate for Payer: Cofinity Commercial |
$851.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.40
|
| Rate for Payer: Healthscope Commercial |
$891.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$742.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.88
|
| Rate for Payer: PHP Commercial |
$841.92
|
| Rate for Payer: Priority Health SBD |
$624.01
|
| Rate for Payer: UMR Bronson Commercial |
$435.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$742.88
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$990.50
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$366.49 |
| Max. Negotiated Rate |
$891.45 |
| Rate for Payer: Aetna American Axle |
$643.83
|
| Rate for Payer: Aetna Commercial |
$841.92
|
| Rate for Payer: Aetna Medicare |
$495.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.83
|
| Rate for Payer: BCBS Complete |
$396.20
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: Cofinity Advantage |
$693.35
|
| Rate for Payer: Cofinity Commercial |
$851.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.40
|
| Rate for Payer: Healthscope Commercial |
$891.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$742.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.88
|
| Rate for Payer: PHP Commercial |
$841.92
|
| Rate for Payer: Priority Health SBD |
$624.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$643.83
|
| Rate for Payer: UHC Core |
$516.05
|
| Rate for Payer: UHC Exchange |
$389.27
|
| Rate for Payer: UMR Bronson Commercial |
$366.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$742.88
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.82
|
|
|
Service Code
|
NDC 60687040711
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$7.94 |
| Rate for Payer: Aetna American Axle |
$5.73
|
| Rate for Payer: Aetna Commercial |
$7.50
|
| Rate for Payer: Aetna Medicare |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.73
|
| Rate for Payer: BCBS Complete |
$3.53
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Advantage |
$6.17
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$7.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.62
|
| Rate for Payer: PHP Commercial |
$7.50
|
| Rate for Payer: Priority Health SBD |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.73
|
| Rate for Payer: UHC Core |
$4.60
|
| Rate for Payer: UHC Exchange |
$3.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.62
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
NDC 27808003601
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Advantage |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.75
|
| Rate for Payer: UHC Core |
$91.17
|
| Rate for Payer: UHC Exchange |
$68.78
|
| Rate for Payer: UMR Bronson Commercial |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$341.25
|
|
|
Service Code
|
NDC 65162011510
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna American Axle |
$221.81
|
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna Medicare |
$170.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.81
|
| Rate for Payer: BCBS Complete |
$136.50
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Advantage |
$238.88
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.94
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health SBD |
$214.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.81
|
| Rate for Payer: UHC Core |
$177.79
|
| Rate for Payer: UHC Exchange |
$134.11
|
| Rate for Payer: UMR Bronson Commercial |
$126.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
NDC 27808003601
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna American Axle |
$113.75
|
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Advantage |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: UMR Bronson Commercial |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$341.25
|
|
|
Service Code
|
NDC 65162011510
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.15 |
| Max. Negotiated Rate |
$307.12 |
| Rate for Payer: Aetna American Axle |
$221.81
|
| Rate for Payer: Aetna Commercial |
$290.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.81
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cofinity Advantage |
$238.88
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.00
|
| Rate for Payer: Healthscope Commercial |
$307.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.94
|
| Rate for Payer: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health SBD |
$214.99
|
| Rate for Payer: UMR Bronson Commercial |
$150.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: Aetna American Axle |
$6.44
|
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.44
|
| 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: 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: UMR Bronson Commercial |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.43
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
NDC 60687040701
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna American Axle |
$573.30
|
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.30
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Advantage |
$617.40
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$661.50
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: Priority Health SBD |
$555.66
|
| Rate for Payer: UMR Bronson Commercial |
$388.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$530.25
|
|
|
Service Code
|
NDC 00904682661
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.19 |
| Max. Negotiated Rate |
$477.23 |
| Rate for Payer: Aetna American Axle |
$344.66
|
| Rate for Payer: Aetna Commercial |
$450.71
|
| Rate for Payer: Aetna Medicare |
$265.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.66
|
| Rate for Payer: BCBS Complete |
$212.10
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cofinity Advantage |
$371.18
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.20
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$397.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$424.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.69
|
| Rate for Payer: PHP Commercial |
$450.71
|
| Rate for Payer: Priority Health SBD |
$334.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$344.66
|
| Rate for Payer: UHC Core |
$276.26
|
| Rate for Payer: UHC Exchange |
$208.39
|
| Rate for Payer: UMR Bronson Commercial |
$196.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$2,432.50
|
|
|
Service Code
|
NDC 65162011511
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,070.30 |
| Max. Negotiated Rate |
$2,189.25 |
| Rate for Payer: Aetna American Axle |
$1,581.12
|
| Rate for Payer: Aetna Commercial |
$2,067.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.12
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: Cofinity Advantage |
$1,702.75
|
| Rate for Payer: Cofinity Commercial |
$2,091.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,946.00
|
| Rate for Payer: Healthscope Commercial |
$2,189.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,067.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,824.38
|
| Rate for Payer: PHP Commercial |
$2,067.62
|
| Rate for Payer: Priority Health SBD |
$1,532.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,070.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.38
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$2,432.50
|
|
|
Service Code
|
NDC 65162011511
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$900.02 |
| Max. Negotiated Rate |
$2,189.25 |
| Rate for Payer: Aetna American Axle |
$1,581.12
|
| Rate for Payer: Aetna Commercial |
$2,067.62
|
| Rate for Payer: Aetna Medicare |
$1,216.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.12
|
| Rate for Payer: BCBS Complete |
$973.00
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: Cofinity Advantage |
$1,702.75
|
| Rate for Payer: Cofinity Commercial |
$2,091.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,946.00
|
| Rate for Payer: Healthscope Commercial |
$2,189.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,702.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,824.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,946.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,067.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,824.38
|
| Rate for Payer: PHP Commercial |
$2,067.62
|
| Rate for Payer: Priority Health SBD |
$1,532.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,581.12
|
| Rate for Payer: UHC Core |
$1,267.33
|
| Rate for Payer: UHC Exchange |
$955.97
|
| Rate for Payer: UMR Bronson Commercial |
$900.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.38
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$8.12
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna American Axle |
$5.28
|
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.28
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Advantage |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$7.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.09
|
| Rate for Payer: PHP Commercial |
$6.90
|
| Rate for Payer: Priority Health SBD |
$5.12
|
| Rate for Payer: UMR Bronson Commercial |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.09
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$7.30
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna American Axle |
$4.75
|
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.75
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: Cofinity Advantage |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.84
|
| Rate for Payer: Healthscope Commercial |
$6.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.47
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: Priority Health SBD |
$4.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.75
|
| Rate for Payer: UHC Core |
$3.80
|
| Rate for Payer: UHC Exchange |
$2.87
|
| Rate for Payer: UMR Bronson Commercial |
$2.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.47
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$8.12
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna American Axle |
$5.28
|
| Rate for Payer: Aetna Commercial |
$6.90
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.28
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cofinity Advantage |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$7.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.09
|
| Rate for Payer: PHP Commercial |
$6.90
|
| Rate for Payer: Priority Health SBD |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.28
|
| Rate for Payer: UHC Core |
$4.23
|
| Rate for Payer: UHC Exchange |
$3.19
|
| Rate for Payer: UMR Bronson Commercial |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.09
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$7.30
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna American Axle |
$4.75
|
| Rate for Payer: Aetna Commercial |
$6.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.75
|
| Rate for Payer: Cash Price |
$5.84
|
| Rate for Payer: Cofinity Advantage |
$5.11
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.84
|
| Rate for Payer: Healthscope Commercial |
$6.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.47
|
| Rate for Payer: PHP Commercial |
$6.21
|
| Rate for Payer: Priority Health SBD |
$4.60
|
| Rate for Payer: UMR Bronson Commercial |
$3.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.47
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$164.97
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.59 |
| Max. Negotiated Rate |
$148.47 |
| Rate for Payer: Aetna American Axle |
$107.23
|
| Rate for Payer: Aetna Commercial |
$140.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.23
|
| Rate for Payer: Cash Price |
$131.98
|
| Rate for Payer: Cofinity Advantage |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$141.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.98
|
| Rate for Payer: Healthscope Commercial |
$148.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.73
|
| Rate for Payer: PHP Commercial |
$140.22
|
| Rate for Payer: Priority Health SBD |
$103.93
|
| Rate for Payer: UMR Bronson Commercial |
$72.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.73
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$164.97
|
|
|
Service Code
|
NDC 62559013811
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.59 |
| Max. Negotiated Rate |
$148.47 |
| Rate for Payer: Aetna American Axle |
$107.23
|
| Rate for Payer: Aetna Commercial |
$140.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.23
|
| Rate for Payer: Cash Price |
$131.98
|
| Rate for Payer: Cofinity Advantage |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$141.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.98
|
| Rate for Payer: Healthscope Commercial |
$148.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.73
|
| Rate for Payer: PHP Commercial |
$140.22
|
| Rate for Payer: Priority Health SBD |
$103.93
|
| Rate for Payer: UMR Bronson Commercial |
$72.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.73
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
OP
|
$164.97
|
|
|
Service Code
|
NDC 62559013811
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$148.47 |
| Rate for Payer: Aetna American Axle |
$107.23
|
| Rate for Payer: Aetna Commercial |
$140.22
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.23
|
| Rate for Payer: BCBS Complete |
$65.99
|
| Rate for Payer: Cash Price |
$131.98
|
| Rate for Payer: Cofinity Advantage |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$141.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.98
|
| Rate for Payer: Healthscope Commercial |
$148.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.73
|
| Rate for Payer: PHP Commercial |
$140.22
|
| Rate for Payer: Priority Health SBD |
$103.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.23
|
| Rate for Payer: UHC Core |
$85.95
|
| Rate for Payer: UHC Exchange |
$64.83
|
| Rate for Payer: UMR Bronson Commercial |
$61.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.73
|
|
