|
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 Commercial |
$238.88
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.88
|
| 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: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| 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
|
OP
|
$204.75
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna Medicare |
$102.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: BCBS Complete |
$81.90
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$75.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$757.75
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.41 |
| Max. Negotiated Rate |
$681.98 |
| Rate for Payer: Aetna American Axle |
$492.54
|
| Rate for Payer: Aetna Commercial |
$644.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.54
|
| 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 |
$333.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$568.31
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.33
|
|
|
Service Code
|
NDC 60687040711
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna Commercial |
$7.08
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: BCBS Complete |
$3.33
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$5.83
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health SBD |
$5.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.25
|
|
|
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 Commercial |
$1,702.75
|
| Rate for Payer: Cofinity Commercial |
$2,091.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,702.75
|
| 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: PHP Commercial |
$2,067.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,581.12
|
| Rate for Payer: Priority Health SBD |
$1,532.47
|
| Rate for Payer: UMR Bronson Commercial |
$900.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,824.38
|
|
|
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 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 |
$64.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.25
|
|
|
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 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 |
$233.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$397.69
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.33
|
|
|
Service Code
|
NDC 60687040711
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna Commercial |
$7.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$5.83
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health SBD |
$5.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.25
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
NDC 00603389121
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UMR Bronson Commercial |
$301.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.34 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna American Axle |
$4.93
|
| Rate for Payer: Aetna Commercial |
$6.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.93
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$5.31
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.44
|
| Rate for Payer: PHP Commercial |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.93
|
| Rate for Payer: Priority Health SBD |
$4.78
|
| Rate for Payer: UMR Bronson Commercial |
$3.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.68
|
|
|
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 Commercial |
$1,702.75
|
| Rate for Payer: Cofinity Commercial |
$2,091.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,702.75
|
| 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: PHP Commercial |
$2,067.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,581.12
|
| 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
|
$7.58
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.82 |
| Rate for Payer: Aetna American Axle |
$4.93
|
| Rate for Payer: Aetna Commercial |
$6.44
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.93
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$5.31
|
| Rate for Payer: Cofinity Commercial |
$6.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$6.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.44
|
| Rate for Payer: PHP Commercial |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.93
|
| Rate for Payer: Priority Health SBD |
$4.78
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.68
|
|
|
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 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 |
$1,262.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,559.38
|
|
|
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 Commercial |
$238.88
|
| Rate for Payer: Cofinity Commercial |
$293.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.88
|
| 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: PHP Commercial |
$290.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.81
|
| Rate for Payer: Priority Health SBD |
$214.99
|
| 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
|
$204.75
|
|
|
Service Code
|
NDC 71930002012
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$90.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
NDC 60687040701
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.21 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Aetna American Axle |
$541.45
|
| Rate for Payer: Aetna Commercial |
$708.05
|
| Rate for Payer: Aetna Medicare |
$416.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.45
|
| Rate for Payer: BCBS Complete |
$333.20
|
| 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 |
$308.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.75
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
NDC 00603389121
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna American Axle |
$445.90
|
| Rate for Payer: Aetna Commercial |
$583.10
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.90
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$480.20
|
| Rate for Payer: Cofinity Commercial |
$589.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.80
|
| Rate for Payer: Healthscope Commercial |
$617.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$480.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$514.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.10
|
| Rate for Payer: PHP Commercial |
$583.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health SBD |
$432.18
|
| Rate for Payer: UMR Bronson Commercial |
$253.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$514.50
|
|
|
HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$620.82
|
|
|
Service Code
|
NDC 50383004316
|
| Hospital Charge Code |
3724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.16 |
| Max. Negotiated Rate |
$558.74 |
| Rate for Payer: Aetna American Axle |
$403.53
|
| Rate for Payer: Aetna Commercial |
$527.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.53
|
| Rate for Payer: Cash Price |
$496.66
|
| Rate for Payer: Cofinity Commercial |
$434.57
|
| Rate for Payer: Cofinity Commercial |
$533.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$558.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.70
|
| Rate for Payer: PHP Commercial |
$527.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.53
|
| Rate for Payer: Priority Health SBD |
$391.12
|
| Rate for Payer: UMR Bronson Commercial |
$273.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.62
|
|
|
HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$620.82
|
|
|
Service Code
|
NDC 50383004316
|
| Hospital Charge Code |
3724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.70 |
| Max. Negotiated Rate |
$558.74 |
| Rate for Payer: Aetna American Axle |
$403.53
|
| Rate for Payer: Aetna Commercial |
$527.70
|
| Rate for Payer: Aetna Medicare |
$310.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.53
|
| Rate for Payer: BCBS Complete |
$248.33
|
| Rate for Payer: Cash Price |
$496.66
|
| Rate for Payer: Cofinity Commercial |
$434.57
|
| Rate for Payer: Cofinity Commercial |
$533.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$558.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.70
|
| Rate for Payer: PHP Commercial |
$527.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.53
|
| Rate for Payer: Priority Health SBD |
$391.12
|
| Rate for Payer: UMR Bronson Commercial |
$229.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.62
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: BCBS Complete |
$2.78
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$6.25 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$7.74
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.19
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.19
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$138.18
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.82
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$138.18
|
|
|
Service Code
|
NDC 62559013811
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.82
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
