|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna American Axle |
$9.66
|
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$365.26
|
|
|
Service Code
|
NDC 71930002743
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.71 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna American Axle |
$237.42
|
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.42
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.47
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.42
|
| Rate for Payer: Priority Health SBD |
$230.11
|
| Rate for Payer: UMR Bronson Commercial |
$160.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
NDC 00121231650
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.38
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna Medicare |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: BCBS Complete |
$6.55
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna American Axle |
$9.66
|
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
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 Commercial |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.81
|
| 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: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| 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
|
IP
|
$597.83
|
|
|
Service Code
|
NDC 64950034316
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.05 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Aetna American Axle |
$388.59
|
| Rate for Payer: Aetna Commercial |
$508.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.59
|
| Rate for Payer: Cash Price |
$478.26
|
| Rate for Payer: Cofinity Commercial |
$418.48
|
| Rate for Payer: Cofinity Commercial |
$514.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.26
|
| Rate for Payer: Healthscope Commercial |
$538.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.16
|
| Rate for Payer: PHP Commercial |
$508.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.59
|
| Rate for Payer: Priority Health SBD |
$376.63
|
| Rate for Payer: UMR Bronson Commercial |
$263.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.37
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna American Axle |
$9.66
|
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$5.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.38
|
|
|
Service Code
|
NDC 00121231650
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.38
|
|
|
Service Code
|
NDC 00121231615
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.21 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: Aetna American Axle |
$10.65
|
| Rate for Payer: Aetna Commercial |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.65
|
| Rate for Payer: Cash Price |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$14.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.10
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.92
|
| Rate for Payer: PHP Commercial |
$13.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.65
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.29
|
|
|
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 Commercial |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.81
|
| 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: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| 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
|
$365.26
|
|
|
Service Code
|
NDC 71930002743
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$328.73 |
| Rate for Payer: Aetna American Axle |
$237.42
|
| Rate for Payer: Aetna Commercial |
$310.47
|
| Rate for Payer: Aetna Medicare |
$182.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.42
|
| Rate for Payer: BCBS Complete |
$146.10
|
| Rate for Payer: Cash Price |
$292.21
|
| Rate for Payer: Cofinity Commercial |
$255.68
|
| Rate for Payer: Cofinity Commercial |
$314.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$255.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.21
|
| Rate for Payer: Healthscope Commercial |
$328.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.47
|
| Rate for Payer: PHP Commercial |
$310.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.42
|
| Rate for Payer: Priority Health SBD |
$230.11
|
| Rate for Payer: UMR Bronson Commercial |
$135.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.94
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$13.37 |
| Rate for Payer: Aetna American Axle |
$9.66
|
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.66
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$10.40
|
| Rate for Payer: Cofinity Commercial |
$12.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: PHP Commercial |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health SBD |
$9.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.14
|
|
|
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 Commercial |
$60.09
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.09
|
| 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: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.80
|
| 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
|
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 Commercial |
$60.09
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.09
|
| 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: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.80
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| 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 Commercial |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.81
|
| 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: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| 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
|
OP
|
$597.83
|
|
|
Service Code
|
NDC 64950034316
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Aetna American Axle |
$388.59
|
| Rate for Payer: Aetna Commercial |
$508.16
|
| Rate for Payer: Aetna Medicare |
$298.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.59
|
| Rate for Payer: BCBS Complete |
$239.13
|
| Rate for Payer: Cash Price |
$478.26
|
| Rate for Payer: Cofinity Commercial |
$418.48
|
| Rate for Payer: Cofinity Commercial |
$514.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$418.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$478.26
|
| Rate for Payer: Healthscope Commercial |
$538.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$418.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$448.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$508.16
|
| Rate for Payer: PHP Commercial |
$508.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.59
|
| Rate for Payer: Priority Health SBD |
$376.63
|
| Rate for Payer: UMR Bronson Commercial |
$221.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$448.37
|
|
|
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 Commercial |
$10.81
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.81
|
| 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: PHP Commercial |
$13.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health SBD |
$9.73
|
| 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 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 Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.50
|
| 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: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| 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
|
OP
|
$757.75
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.37 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna American Axle |
$492.54
|
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Aetna Medicare |
$378.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.54
|
| Rate for Payer: BCBS Complete |
$303.10
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cofinity Commercial |
$530.42
|
| Rate for Payer: Cofinity Commercial |
$651.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.20
|
| Rate for Payer: Healthscope Commercial |
$681.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$530.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$568.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.09
|
| Rate for Payer: PHP Commercial |
$644.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.54
|
| Rate for Payer: Priority Health SBD |
$477.38
|
| Rate for Payer: UMR Bronson Commercial |
$280.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.31
|
|
|
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 Commercial |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$5.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.16
|
| 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: PHP Commercial |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.86
|
| 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
|
|
|
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 Commercial |
$4.16
|
| Rate for Payer: Cofinity Commercial |
$5.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.16
|
| 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: PHP Commercial |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.86
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| 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
|
$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 Commercial |
$371.18
|
| Rate for Payer: Cofinity Commercial |
$456.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.18
|
| 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: PHP Commercial |
$450.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.66
|
| Rate for Payer: Priority Health SBD |
$334.06
|
| 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
|
$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 Commercial |
$2,388.75
|
| Rate for Payer: Cofinity Commercial |
$2,934.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,388.75
|
| 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: PHP Commercial |
$2,900.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,218.12
|
| 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
|
$833.00
|
|
|
Service Code
|
NDC 60687040701
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Aetna American Axle |
$541.45
|
| Rate for Payer: Aetna Commercial |
$708.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.45
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$583.10
|
| Rate for Payer: Cofinity Commercial |
$716.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$583.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$666.40
|
| Rate for Payer: Healthscope Commercial |
$749.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$708.05
|
| Rate for Payer: PHP Commercial |
$708.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health SBD |
$524.79
|
| Rate for Payer: UMR Bronson Commercial |
$366.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.75
|
|
