|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: UMR Bronson Commercial |
$35.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$241.50
|
|
|
Service Code
|
NDC 53746011001
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$217.35 |
| Rate for Payer: Aetna American Axle |
$156.97
|
| Rate for Payer: Aetna Commercial |
$205.28
|
| Rate for Payer: Aetna Medicare |
$120.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.97
|
| Rate for Payer: BCBS Complete |
$96.60
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$169.05
|
| Rate for Payer: Cofinity Commercial |
$207.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.20
|
| Rate for Payer: Healthscope Commercial |
$217.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.28
|
| Rate for Payer: PHP Commercial |
$205.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.97
|
| Rate for Payer: Priority Health SBD |
$152.15
|
| Rate for Payer: UMR Bronson Commercial |
$89.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.12
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
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 Commercial |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.04
|
| 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: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: Priority Health SBD |
$5.44
|
| 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
|
$700.00
|
|
|
Service Code
|
NDC 60687039601
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna American Axle |
$455.00
|
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health SBD |
$441.00
|
| Rate for Payer: UMR Bronson Commercial |
$308.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.00
|
|
|
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 Commercial |
$214.62
|
| Rate for Payer: Cofinity Commercial |
$263.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.62
|
| 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: PHP Commercial |
$260.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.29
|
| 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
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 60687039611
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna American Axle |
$4.55
|
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.55
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.95
|
| Rate for Payer: PHP Commercial |
$5.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health SBD |
$4.41
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.25
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna American Axle |
$41.41
|
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.41
|
| Rate for Payer: BCBS Complete |
$25.48
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$44.59
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| Rate for Payer: Priority Health SBD |
$40.13
|
| Rate for Payer: UMR Bronson Commercial |
$23.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
NDC 53746010901
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$72.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
NDC 53746010905
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna American Axle |
$591.50
|
| Rate for Payer: Aetna Commercial |
$773.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.50
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cofinity Commercial |
$637.00
|
| Rate for Payer: Cofinity Commercial |
$782.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$637.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.00
|
| Rate for Payer: Healthscope Commercial |
$819.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$637.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$682.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$773.50
|
| Rate for Payer: PHP Commercial |
$773.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health SBD |
$573.30
|
| Rate for Payer: UMR Bronson Commercial |
$400.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$682.50
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna American Axle |
$4.14
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.14
|
| Rate for Payer: BCBS Complete |
$2.55
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
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 Commercial |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.85
|
| 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: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.57
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| 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
|
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 Commercial |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.85
|
| 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: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.57
|
| 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
|
$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 Commercial |
$214.62
|
| Rate for Payer: Cofinity Commercial |
$263.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.62
|
| 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: PHP Commercial |
$260.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.29
|
| Rate for Payer: Priority Health SBD |
$193.16
|
| 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
|
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 Commercial |
$271.95
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.95
|
| 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: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.53
|
| 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
|
$196.00
|
|
|
Service Code
|
NDC 53746010901
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$86.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
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 Commercial |
$271.95
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.95
|
| 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: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.53
|
| Rate for Payer: Priority Health SBD |
$244.75
|
| 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
|
$246.75
|
|
|
Service Code
|
NDC 57664012688
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$246.75
|
|
|
Service Code
|
NDC 57664012688
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$222.07 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna Medicare |
$123.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: BCBS Complete |
$98.70
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.39
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$91.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 60687039611
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna American Axle |
$4.55
|
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.55
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.95
|
| Rate for Payer: PHP Commercial |
$5.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health SBD |
$4.41
|
| Rate for Payer: UMR Bronson Commercial |
$2.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.25
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Aetna American Axle |
$4.14
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.14
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$5.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$5.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.78
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna American Axle |
$41.41
|
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.41
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$44.59
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.41
|
| Rate for Payer: Priority Health SBD |
$40.13
|
| Rate for Payer: UMR Bronson Commercial |
$28.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
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 Commercial |
$6.04
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.04
|
| 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: PHP Commercial |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| 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
|
OP
|
$700.00
|
|
|
Service Code
|
NDC 60687039601
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna American Axle |
$455.00
|
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna Medicare |
$350.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: BCBS Complete |
$280.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$490.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health SBD |
$441.00
|
| Rate for Payer: UMR Bronson Commercial |
$259.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.00
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
NDC 53746010905
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.70 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna American Axle |
$591.50
|
| Rate for Payer: Aetna Commercial |
$773.50
|
| Rate for Payer: Aetna Medicare |
$455.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.50
|
| Rate for Payer: BCBS Complete |
$364.00
|
| Rate for Payer: Cash Price |
$728.00
|
| Rate for Payer: Cofinity Commercial |
$637.00
|
| Rate for Payer: Cofinity Commercial |
$782.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$637.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$728.00
|
| Rate for Payer: Healthscope Commercial |
$819.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$637.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$682.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$773.50
|
| Rate for Payer: PHP Commercial |
$773.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$591.50
|
| Rate for Payer: Priority Health SBD |
$573.30
|
| Rate for Payer: UMR Bronson Commercial |
$336.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$682.50
|
|
