|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$46.06
|
|
|
Service Code
|
NDC 406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$46.06 |
| Rate for Payer: Aetna Commercial |
$41.45
|
| Rate for Payer: Aetna Medicare |
$17.04
|
| Rate for Payer: ASR ASR |
$44.68
|
| Rate for Payer: BCBS Complete |
$18.42
|
| Rate for Payer: BCBS Trust/PPO |
$37.98
|
| Rate for Payer: BCN Commercial |
$37.98
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$44.68
|
| Rate for Payer: Healthscope Whirlpool |
$46.06
|
| Rate for Payer: Mclaren Commercial |
$41.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.15
|
| Rate for Payer: Nomi Health Commercial |
$37.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40.36
|
| Rate for Payer: Priority Health Narrow Network |
$32.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.53
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$305.38
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$305.38 |
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: Aetna Medicare |
$112.99
|
| Rate for Payer: ASR ASR |
$296.21
|
| Rate for Payer: BCBS Complete |
$122.15
|
| Rate for Payer: BCBS Trust/PPO |
$251.78
|
| Rate for Payer: BCN Commercial |
$251.78
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: Cofinity Commercial |
$287.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$296.21
|
| Rate for Payer: Healthscope Whirlpool |
$305.38
|
| Rate for Payer: Mclaren Commercial |
$274.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.57
|
| Rate for Payer: Nomi Health Commercial |
$250.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.57
|
| Rate for Payer: Priority Health Narrow Network |
$214.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.73
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$305.38
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.03 |
| Max. Negotiated Rate |
$305.38 |
| Rate for Payer: Aetna Commercial |
$274.84
|
| Rate for Payer: ASR ASR |
$296.21
|
| Rate for Payer: BCBS Trust/PPO |
$250.77
|
| Rate for Payer: BCN Commercial |
$250.77
|
| Rate for Payer: Cash Price |
$244.30
|
| Rate for Payer: Cofinity Commercial |
$287.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.30
|
| Rate for Payer: Healthscope Commercial |
$296.21
|
| Rate for Payer: Healthscope Whirlpool |
$305.38
|
| Rate for Payer: Mclaren Commercial |
$274.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.57
|
| Rate for Payer: Nomi Health Commercial |
$250.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.73
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$46.06
|
|
|
Service Code
|
NDC 406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.55 |
| Max. Negotiated Rate |
$46.06 |
| Rate for Payer: Aetna Commercial |
$41.45
|
| Rate for Payer: ASR ASR |
$44.68
|
| Rate for Payer: BCBS Trust/PPO |
$37.82
|
| Rate for Payer: BCN Commercial |
$37.82
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cofinity Commercial |
$43.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.85
|
| Rate for Payer: Healthscope Commercial |
$44.68
|
| Rate for Payer: Healthscope Whirlpool |
$46.06
|
| Rate for Payer: Mclaren Commercial |
$41.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.15
|
| Rate for Payer: Nomi Health Commercial |
$37.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.53
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.11
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: Aetna Commercial |
$5.50
|
| Rate for Payer: ASR ASR |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$5.02
|
| Rate for Payer: BCN Commercial |
$5.02
|
| Rate for Payer: Cash Price |
$4.89
|
| Rate for Payer: Cofinity Commercial |
$5.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.89
|
| Rate for Payer: Healthscope Commercial |
$5.92
|
| Rate for Payer: Healthscope Whirlpool |
$6.11
|
| Rate for Payer: Mclaren Commercial |
$5.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.19
|
| Rate for Payer: Nomi Health Commercial |
$5.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.38
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 406012523
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.80
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.68
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.68
|
| Rate for Payer: Healthscope Commercial |
$4.47
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.04
|
| Rate for Payer: Priority Health Narrow Network |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.05
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: ASR ASR |
$8.37
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.11
|
| Rate for Payer: BCN Commercial |
$7.11
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Whirlpool |
$8.63
|
| Rate for Payer: Mclaren Commercial |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.56
|
| Rate for Payer: Priority Health Narrow Network |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$86.28
|
|
|
Service Code
|
NDC 406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.71 |
| Max. Negotiated Rate |
$86.28 |
| Rate for Payer: Aetna Commercial |
$77.65
|
| Rate for Payer: ASR ASR |
$83.69
|
| Rate for Payer: BCBS Trust/PPO |
$70.85
|
| Rate for Payer: BCN Commercial |
$70.85
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$81.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$83.69
|
| Rate for Payer: Healthscope Whirlpool |
$86.28
|
| Rate for Payer: Mclaren Commercial |
$77.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.33
|
| Rate for Payer: Nomi Health Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.92
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$196.88
|
|
|
Service Code
|
NDC 50268040115
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.66 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$177.19
|
| Rate for Payer: ASR ASR |
$190.97
|
| Rate for Payer: BCBS Trust/PPO |
$161.67
|
| Rate for Payer: BCN Commercial |
$161.67
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$185.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$190.97
|
| Rate for Payer: Healthscope Whirlpool |
$196.88
|
| Rate for Payer: Mclaren Commercial |
$177.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.34
|
| Rate for Payer: Nomi Health Commercial |
$161.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.25
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$862.75
|
|
|
Service Code
|
NDC 68084089501
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$647.06 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Aetna Commercial |
$776.48
|
| Rate for Payer: ASR ASR |
$836.87
|
| Rate for Payer: BCBS Trust/PPO |
$708.49
|
| Rate for Payer: BCN Commercial |
$708.49
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$810.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$836.87
|
| Rate for Payer: Healthscope Whirlpool |
$862.75
|
| Rate for Payer: Mclaren Commercial |
$776.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$759.22
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
NDC 50268040111
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: ASR ASR |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$3.23
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$3.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Nomi Health Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: ASR ASR |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Whirlpool |
$8.63
|
| Rate for Payer: Mclaren Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$8.63
|
|
|
Service Code
|
NDC 68084089511
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: ASR ASR |
$8.37
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.11
|
| Rate for Payer: BCN Commercial |
$7.11
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Whirlpool |
$8.63
|
| Rate for Payer: Mclaren Commercial |
$7.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.56
|
| Rate for Payer: Priority Health Narrow Network |
$6.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,627.50
|
|
|
Service Code
|
NDC 406012305
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,220.62 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,464.75
|
| Rate for Payer: ASR ASR |
$1,578.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,336.50
|
| Rate for Payer: BCN Commercial |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cofinity Commercial |
$1,529.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,302.00
|
| Rate for Payer: Healthscope Commercial |
$1,578.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,627.50
|
| Rate for Payer: Mclaren Commercial |
$1,464.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,383.38
|
| Rate for Payer: Nomi Health Commercial |
$1,334.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,220.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,432.20
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$86.28
|
|
|
Service Code
|
NDC 406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$86.28 |
| Rate for Payer: Aetna Commercial |
$77.65
|
| Rate for Payer: Aetna Medicare |
$31.92
|
| Rate for Payer: ASR ASR |
$83.69
|
| Rate for Payer: BCBS Complete |
$34.51
|
| Rate for Payer: BCBS Trust/PPO |
$71.13
|
| Rate for Payer: BCN Commercial |
$71.13
|
| Rate for Payer: Cash Price |
$69.02
|
| Rate for Payer: Cofinity Commercial |
$81.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.02
|
| Rate for Payer: Healthscope Commercial |
$83.69
|
| Rate for Payer: Healthscope Whirlpool |
$86.28
|
| Rate for Payer: Mclaren Commercial |
$77.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.33
|
| Rate for Payer: Nomi Health Commercial |
$70.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.59
|
| Rate for Payer: Priority Health Narrow Network |
$60.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.92
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
NDC 50268040111
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: ASR ASR |
$3.82
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Nomi Health Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.45
|
| Rate for Payer: Priority Health Narrow Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.47
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$1,627.50
|
|
|
Service Code
|
NDC 406012305
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$602.17 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,464.75
|
| Rate for Payer: Aetna Medicare |
$602.17
|
| Rate for Payer: ASR ASR |
$1,578.67
|
| Rate for Payer: BCBS Complete |
$651.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,341.87
|
| Rate for Payer: BCN Commercial |
$1,341.87
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cofinity Commercial |
$1,529.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,302.00
|
| Rate for Payer: Healthscope Commercial |
$1,578.67
|
| Rate for Payer: Healthscope Whirlpool |
$1,627.50
|
| Rate for Payer: Mclaren Commercial |
$1,464.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,302.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,383.38
|
| Rate for Payer: Nomi Health Commercial |
$1,334.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,220.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,426.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,432.20
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$196.88
|
|
|
Service Code
|
NDC 50268040115
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.84 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$177.19
|
| Rate for Payer: Aetna Medicare |
$72.84
|
| Rate for Payer: ASR ASR |
$190.97
|
| Rate for Payer: BCBS Complete |
$78.75
|
| Rate for Payer: BCBS Trust/PPO |
$162.32
|
| Rate for Payer: BCN Commercial |
$162.32
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cofinity Commercial |
$185.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.50
|
| Rate for Payer: Healthscope Commercial |
$190.97
|
| Rate for Payer: Healthscope Whirlpool |
$196.88
|
| Rate for Payer: Mclaren Commercial |
$177.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.34
|
| Rate for Payer: Nomi Health Commercial |
$161.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.50
|
| Rate for Payer: Priority Health Narrow Network |
$138.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.25
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$8.63
|
|
|
Service Code
|
NDC 406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: ASR ASR |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$7.09
|
| Rate for Payer: BCN Commercial |
$7.09
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.90
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Whirlpool |
$8.63
|
| Rate for Payer: Mclaren Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.33
|
| Rate for Payer: Nomi Health Commercial |
$7.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$862.75
|
|
|
Service Code
|
NDC 68084089501
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.22 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Aetna Commercial |
$776.48
|
| Rate for Payer: Aetna Medicare |
$319.22
|
| Rate for Payer: ASR ASR |
$836.87
|
| Rate for Payer: BCBS Complete |
$345.10
|
| Rate for Payer: BCBS Trust/PPO |
$711.34
|
| Rate for Payer: BCN Commercial |
$711.34
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$810.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$836.87
|
| Rate for Payer: Healthscope Whirlpool |
$862.75
|
| Rate for Payer: Mclaren Commercial |
$776.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$690.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.34
|
| Rate for Payer: Nomi Health Commercial |
$707.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$755.94
|
| Rate for Payer: Priority Health Narrow Network |
$604.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$759.22
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.44
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| Rate for Payer: ASR ASR |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$14.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.36
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Whirlpool |
$15.44
|
| Rate for Payer: Mclaren Commercial |
$13.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.13
|
| Rate for Payer: Nomi Health Commercial |
$12.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.53
|
| Rate for Payer: Priority Health Narrow Network |
$10.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: Aetna Medicare |
$6.04
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Trust/PPO |
$13.46
|
| Rate for Payer: BCN Commercial |
$13.46
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$15.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.32
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.30
|
| Rate for Payer: Priority Health Narrow Network |
$11.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
NDC 121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.17
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Nomi Health Commercial |
$34.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.35
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna Commercial |
$14.69
|
| Rate for Payer: ASR ASR |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$13.40
|
| Rate for Payer: BCN Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$15.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$15.83
|
| Rate for Payer: Healthscope Whirlpool |
$16.32
|
| Rate for Payer: Mclaren Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.36
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$10.12
|
|
|
Service Code
|
NDC 9900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: ASR ASR |
$9.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.31
|
| Rate for Payer: BCN Commercial |
$8.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.82
|
| Rate for Payer: Healthscope Whirlpool |
$10.12
|
| Rate for Payer: Mclaren Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.60
|
| Rate for Payer: Nomi Health Commercial |
$8.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.91
|
|
