|
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
|
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
|
|
|
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
|
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 |
$252.52
|
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.52
|
| 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 |
$330.22
|
| Rate for Payer: PHP Commercial |
$330.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.52
|
| Rate for Payer: Priority Health SBD |
$244.76
|
| 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
|
OP
|
$388.50
|
|
|
Service Code
|
NDC 00904682461
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.74 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna American Axle |
$252.52
|
| Rate for Payer: Aetna Commercial |
$330.22
|
| Rate for Payer: Aetna Medicare |
$194.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.52
|
| 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 |
$330.22
|
| Rate for Payer: PHP Commercial |
$330.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.52
|
| Rate for Payer: Priority Health SBD |
$244.76
|
| Rate for Payer: UMR Bronson Commercial |
$143.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.38
|
|
|
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 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 |
$12.28
|
| 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 |
$12.28
|
|
|
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 |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.82
|
| 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 |
$10.82
|
| 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
|
$85.85
|
|
|
Service Code
|
NDC 00121077216
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$77.26 |
| 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 |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Healthscope Commercial |
$77.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.10
|
| 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
|
$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
|
$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
|
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 Medicare |
$7.43
|
| 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: 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
|
$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 |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.82
|
| 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 |
$10.82
|
| 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
|
$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 |
$12.28
|
| 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 |
$12.28
|
|
|
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
|
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
|
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 |
$12.28
|
| 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 |
$12.28
|
|
|
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 |
$12.28
|
| 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 |
$12.28
|
|
|
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
|
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 |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.82
|
| 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 |
$10.82
|
| 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
|
$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 |
$10.82
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.82
|
| 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 |
$10.82
|
| 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
|
IP
|
$85.85
|
|
|
Service Code
|
NDC 00121077216
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$77.26 |
| 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 |
$60.10
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Healthscope Commercial |
$77.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.10
|
| 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
|
$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 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
|
|
