|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$15.44
|
|
|
Service Code
|
NDC 66689002350
|
| 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
|
$10.12
|
|
|
Service Code
|
NDC 9900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$3.74
|
| Rate for Payer: ASR ASR |
$9.82
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCN Commercial |
$8.34
|
| 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: MI Amish Medical Board Commercial |
$8.10
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.87
|
| Rate for Payer: Priority Health Narrow Network |
$7.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.91
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
NDC 60687041771
|
| 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
|
$16.32
|
|
|
Service Code
|
NDC 60687041744
|
| 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
|
$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
|
OP
|
$42.45
|
|
|
Service Code
|
NDC 121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$15.70
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| 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: MI Amish Medical Board Commercial |
$33.96
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.35
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.44
|
|
|
Service Code
|
NDC 66689002350
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: ASR ASR |
$14.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$12.68
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$13.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$276.50
|
|
|
Service Code
|
NDC 50268040015
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.31 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Aetna Commercial |
$248.85
|
| Rate for Payer: Aetna Medicare |
$102.31
|
| Rate for Payer: ASR ASR |
$268.20
|
| Rate for Payer: BCBS Complete |
$110.60
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$227.97
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.20
|
| Rate for Payer: Healthscope Commercial |
$268.20
|
| Rate for Payer: Healthscope Whirlpool |
$276.50
|
| Rate for Payer: Mclaren Commercial |
$248.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.03
|
| Rate for Payer: Nomi Health Commercial |
$226.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$242.27
|
| Rate for Payer: Priority Health Narrow Network |
$193.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.32
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$276.50
|
|
|
Service Code
|
NDC 50268040015
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.38 |
| Max. Negotiated Rate |
$276.50 |
| Rate for Payer: Aetna Commercial |
$248.85
|
| Rate for Payer: ASR ASR |
$268.20
|
| Rate for Payer: BCBS Trust/PPO |
$227.06
|
| Rate for Payer: BCN Commercial |
$227.06
|
| Rate for Payer: Cash Price |
$221.20
|
| Rate for Payer: Cofinity Commercial |
$259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.20
|
| Rate for Payer: Healthscope Commercial |
$268.20
|
| Rate for Payer: Healthscope Whirlpool |
$276.50
|
| Rate for Payer: Mclaren Commercial |
$248.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.03
|
| Rate for Payer: Nomi Health Commercial |
$226.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.32
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
NDC 50268040011
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: ASR ASR |
$5.36
|
| Rate for Payer: BCBS Complete |
$2.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.56
|
| Rate for Payer: BCN Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.42
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.53
|
| Rate for Payer: Mclaren Commercial |
$4.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.70
|
| Rate for Payer: Nomi Health Commercial |
$4.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.85
|
| Rate for Payer: Priority Health Narrow Network |
$3.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.87
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: ASR ASR |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$8.13
|
| Rate for Payer: BCN Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.72
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$5.53
|
|
|
Service Code
|
NDC 50268040011
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.15 |
| Max. Negotiated Rate |
$5.53 |
| Rate for Payer: Aetna Commercial |
$4.98
|
| Rate for Payer: ASR ASR |
$5.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.54
|
| Rate for Payer: BCN Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cofinity Commercial |
$5.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.42
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Healthscope Whirlpool |
$5.53
|
| Rate for Payer: Mclaren Commercial |
$4.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.70
|
| Rate for Payer: Nomi Health Commercial |
$4.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.87
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: ASR ASR |
$9.61
|
| Rate for Payer: BCBS Complete |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$8.17
|
| Rate for Payer: BCN Commercial |
$8.17
|
| Rate for Payer: Cash Price |
$7.92
|
| Rate for Payer: Cofinity Commercial |
$9.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.92
|
| Rate for Payer: Healthscope Commercial |
$9.61
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.42
|
| Rate for Payer: Nomi Health Commercial |
$8.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.68
|
| Rate for Payer: Priority Health Narrow Network |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.72
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$990.50
|
|
|
Service Code
|
NDC 406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$366.49 |
| Max. Negotiated Rate |
$990.50 |
| Rate for Payer: Aetna Commercial |
$891.45
|
| Rate for Payer: Aetna Medicare |
$366.49
|
| Rate for Payer: ASR ASR |
$960.78
|
| Rate for Payer: BCBS Complete |
$396.20
|
| Rate for Payer: BCBS Trust/PPO |
$816.67
|
| Rate for Payer: BCN Commercial |
$816.67
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: Cofinity Commercial |
$931.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.40
|
| Rate for Payer: Healthscope Commercial |
$960.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.50
|
| Rate for Payer: Mclaren Commercial |
$891.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.92
|
| Rate for Payer: Nomi Health Commercial |
$812.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$867.88
|
| Rate for Payer: Priority Health Narrow Network |
$694.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$871.64
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$990.50
|
|
|
Service Code
|
NDC 406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$742.88 |
| Max. Negotiated Rate |
$990.50 |
| Rate for Payer: Aetna Commercial |
$891.45
|
| Rate for Payer: ASR ASR |
$960.78
|
| Rate for Payer: BCBS Trust/PPO |
$813.40
|
| Rate for Payer: BCN Commercial |
$813.40
|
| Rate for Payer: Cash Price |
$792.40
|
| Rate for Payer: Cofinity Commercial |
$931.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.40
|
| Rate for Payer: Healthscope Commercial |
$960.78
|
| Rate for Payer: Healthscope Whirlpool |
$990.50
|
| Rate for Payer: Mclaren Commercial |
$891.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.92
|
| Rate for Payer: Nomi Health Commercial |
$812.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$742.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$871.64
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$398.16
|
|
|
Service Code
|
NDC 50268040615
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$298.62 |
| Max. Negotiated Rate |
$398.16 |
| Rate for Payer: Aetna Commercial |
$358.34
|
| Rate for Payer: ASR ASR |
$386.22
|
| Rate for Payer: BCBS Trust/PPO |
$326.97
|
| Rate for Payer: BCN Commercial |
$326.97
|
| Rate for Payer: Cash Price |
$318.53
|
| Rate for Payer: Cofinity Commercial |
$374.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.53
|
| Rate for Payer: Healthscope Commercial |
$386.22
|
| Rate for Payer: Healthscope Whirlpool |
$398.16
|
| Rate for Payer: Mclaren Commercial |
$358.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.44
|
| Rate for Payer: Nomi Health Commercial |
$326.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.38
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$709.92
|
|
|
Service Code
|
NDC 904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$532.44 |
| Max. Negotiated Rate |
$709.92 |
| Rate for Payer: Aetna Commercial |
$638.93
|
| Rate for Payer: ASR ASR |
$688.62
|
| Rate for Payer: BCBS Trust/PPO |
$582.99
|
| Rate for Payer: BCN Commercial |
$582.99
|
| Rate for Payer: Cash Price |
$567.94
|
| Rate for Payer: Cofinity Commercial |
$667.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.94
|
| Rate for Payer: Healthscope Commercial |
$688.62
|
| Rate for Payer: Healthscope Whirlpool |
$709.92
|
| Rate for Payer: Mclaren Commercial |
$638.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.43
|
| Rate for Payer: Nomi Health Commercial |
$582.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.73
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$398.16
|
|
|
Service Code
|
NDC 50268040615
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.32 |
| Max. Negotiated Rate |
$398.16 |
| Rate for Payer: Aetna Commercial |
$358.34
|
| Rate for Payer: Aetna Medicare |
$147.32
|
| Rate for Payer: ASR ASR |
$386.22
|
| Rate for Payer: BCBS Complete |
$159.26
|
| Rate for Payer: BCBS Trust/PPO |
$328.28
|
| Rate for Payer: BCN Commercial |
$328.28
|
| Rate for Payer: Cash Price |
$318.53
|
| Rate for Payer: Cofinity Commercial |
$374.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.53
|
| Rate for Payer: Healthscope Commercial |
$386.22
|
| Rate for Payer: Healthscope Whirlpool |
$398.16
|
| Rate for Payer: Mclaren Commercial |
$358.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.44
|
| Rate for Payer: Nomi Health Commercial |
$326.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$348.87
|
| Rate for Payer: Priority Health Narrow Network |
$279.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$350.38
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$709.92
|
|
|
Service Code
|
NDC 904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.67 |
| Max. Negotiated Rate |
$709.92 |
| Rate for Payer: Aetna Commercial |
$638.93
|
| Rate for Payer: Aetna Medicare |
$262.67
|
| Rate for Payer: ASR ASR |
$688.62
|
| Rate for Payer: BCBS Complete |
$283.97
|
| Rate for Payer: BCBS Trust/PPO |
$585.33
|
| Rate for Payer: BCN Commercial |
$585.33
|
| Rate for Payer: Cash Price |
$567.94
|
| Rate for Payer: Cofinity Commercial |
$667.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.94
|
| Rate for Payer: Healthscope Commercial |
$688.62
|
| Rate for Payer: Healthscope Whirlpool |
$709.92
|
| Rate for Payer: Mclaren Commercial |
$638.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$567.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.43
|
| Rate for Payer: Nomi Health Commercial |
$582.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$622.03
|
| Rate for Payer: Priority Health Narrow Network |
$497.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$624.73
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$7.96
|
|
|
Service Code
|
NDC 50268040611
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: ASR ASR |
$7.73
|
| Rate for Payer: BCBS Trust/PPO |
$6.54
|
| Rate for Payer: BCN Commercial |
$6.54
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.37
|
| Rate for Payer: Healthscope Commercial |
$7.73
|
| Rate for Payer: Healthscope Whirlpool |
$7.96
|
| Rate for Payer: Mclaren Commercial |
$7.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.77
|
| Rate for Payer: Nomi Health Commercial |
$6.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.01
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$7.96
|
|
|
Service Code
|
NDC 50268040611
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna Medicare |
$2.95
|
| Rate for Payer: ASR ASR |
$7.73
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: BCBS Trust/PPO |
$6.57
|
| Rate for Payer: BCN Commercial |
$6.57
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.37
|
| Rate for Payer: Healthscope Commercial |
$7.73
|
| Rate for Payer: Healthscope Whirlpool |
$7.96
|
| Rate for Payer: Mclaren Commercial |
$7.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.77
|
| Rate for Payer: Nomi Health Commercial |
$6.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.98
|
| Rate for Payer: Priority Health Narrow Network |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.01
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.91
|
|
|
Service Code
|
NDC 9629513687
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: ASR ASR |
$10.58
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: BCBS Trust/PPO |
$8.99
|
| Rate for Payer: BCN Commercial |
$8.99
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Healthscope Whirlpool |
$10.91
|
| Rate for Payer: Mclaren Commercial |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Nomi Health Commercial |
$8.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.56
|
| Rate for Payer: Priority Health Narrow Network |
$7.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.60
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.09 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.51
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.76
|
| Rate for Payer: BCN Commercial |
$7.76
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.17
|
| Rate for Payer: Healthscope Whirlpool |
$9.45
|
| Rate for Payer: Mclaren Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.61
|
|
|
Service Code
|
NDC 51672206902
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Aetna Commercial |
$12.25
|
| Rate for Payer: ASR ASR |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$11.17
|
| Rate for Payer: BCN Commercial |
$11.17
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$13.61
|
| Rate for Payer: Mclaren Commercial |
$12.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Nomi Health Commercial |
$11.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.98
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.51
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.79
|
| Rate for Payer: BCN Commercial |
$7.79
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.17
|
| Rate for Payer: Healthscope Whirlpool |
$9.45
|
| Rate for Payer: Mclaren Commercial |
$8.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.28
|
| Rate for Payer: Priority Health Narrow Network |
$6.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
