|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$5.42
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: ASR ASR |
$5.26
|
| Rate for Payer: ASR Commercial |
$5.26
|
| Rate for Payer: BCBS Trust/PPO |
$4.42
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$5.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Healthscope Whirlpool |
$5.26
|
| Rate for Payer: Mclaren Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.77
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$271.25
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.31 |
| Max. Negotiated Rate |
$271.25 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: ASR ASR |
$263.11
|
| Rate for Payer: ASR Commercial |
$263.11
|
| Rate for Payer: BCBS Trust/PPO |
$221.04
|
| Rate for Payer: BCN Commercial |
$210.30
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$254.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$271.25
|
| Rate for Payer: Healthscope Whirlpool |
$263.11
|
| Rate for Payer: Mclaren Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.70
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: ASR ASR |
$5.26
|
| Rate for Payer: ASR Commercial |
$5.26
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$4.44
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$5.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Healthscope Whirlpool |
$5.26
|
| Rate for Payer: Mclaren Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.77
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$80.33 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: ASR ASR |
$77.92
|
| Rate for Payer: ASR Commercial |
$77.92
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS Trust/PPO |
$65.78
|
| Rate for Payer: BCN Commercial |
$62.28
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$80.33
|
| Rate for Payer: Healthscope Whirlpool |
$77.92
|
| Rate for Payer: Mclaren Commercial |
$72.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.39
|
| Rate for Payer: Priority Health Narrow Network |
$56.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.69
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Aetna Commercial |
$57.33
|
| Rate for Payer: ASR ASR |
$61.79
|
| Rate for Payer: ASR Commercial |
$61.79
|
| Rate for Payer: BCBS Trust/PPO |
$51.91
|
| Rate for Payer: BCN Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$59.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$63.70
|
| Rate for Payer: Healthscope Whirlpool |
$61.79
|
| Rate for Payer: Mclaren Commercial |
$57.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.14
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
NDC 50268040111
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: ASR ASR |
$3.78
|
| Rate for Payer: ASR Commercial |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Healthscope Whirlpool |
$3.78
|
| Rate for Payer: Mclaren Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Nomi Health Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.43
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$6.37
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna Commercial |
$5.73
|
| Rate for Payer: ASR ASR |
$6.18
|
| Rate for Payer: ASR Commercial |
$6.18
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$4.94
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$6.37
|
| Rate for Payer: Healthscope Whirlpool |
$6.18
|
| Rate for Payer: Mclaren Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.61
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$1,627.50
|
|
|
Service Code
|
NDC 00406012305
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,057.88 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,464.75
|
| Rate for Payer: ASR ASR |
$1,578.68
|
| Rate for Payer: ASR Commercial |
$1,578.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.25
|
| Rate for Payer: BCN Commercial |
$1,261.80
|
| 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 |
$1,627.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,578.68
|
| 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: Priority Health Cigna Priority Health |
$1,057.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,432.20
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$6.37
|
|
|
Service Code
|
NDC 00406012323
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna Commercial |
$5.73
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: ASR ASR |
$6.18
|
| Rate for Payer: ASR Commercial |
$6.18
|
| Rate for Payer: BCBS Complete |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$4.94
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$6.37
|
| Rate for Payer: Healthscope Whirlpool |
$6.18
|
| Rate for Payer: Mclaren Commercial |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.58
|
| Rate for Payer: Priority Health Narrow Network |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.61
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$1,627.50
|
|
|
Service Code
|
NDC 00406012305
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna Commercial |
$1,464.75
|
| Rate for Payer: Aetna Medicare |
$813.75
|
| Rate for Payer: ASR ASR |
$1,578.68
|
| Rate for Payer: ASR Commercial |
$1,578.68
|
| Rate for Payer: BCBS Complete |
$651.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.76
|
| Rate for Payer: BCN Commercial |
$1,261.80
|
| 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 |
$1,627.50
|
| Rate for Payer: Healthscope Whirlpool |
$1,578.68
|
| 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: Priority Health Cigna Priority Health |
$1,057.88
|
| Rate for Payer: 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
|
IP
|
$195.12
|
|
|
Service Code
|
NDC 50268040115
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.83 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna Commercial |
$175.61
|
| Rate for Payer: ASR ASR |
$189.27
|
| Rate for Payer: ASR Commercial |
$189.27
|
| Rate for Payer: BCBS Trust/PPO |
$159.00
|
| Rate for Payer: BCN Commercial |
$151.28
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$183.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Healthscope Commercial |
$195.12
|
| Rate for Payer: Healthscope Whirlpool |
$189.27
|
| Rate for Payer: Mclaren Commercial |
$175.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.85
|
| Rate for Payer: Nomi Health Commercial |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.71
|
|
|
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 |
$345.10 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Aetna Commercial |
$776.48
|
| Rate for Payer: Aetna Medicare |
$431.38
|
| Rate for Payer: ASR ASR |
$836.87
|
| Rate for Payer: ASR Commercial |
$836.87
|
| Rate for Payer: BCBS Complete |
$345.10
|
| Rate for Payer: BCBS Trust/PPO |
$706.51
|
| Rate for Payer: BCN Commercial |
$668.89
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$810.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$862.75
|
| Rate for Payer: Healthscope Whirlpool |
$836.87
|
| 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: Priority Health Cigna Priority Health |
$560.79
|
| Rate for Payer: 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 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$195.12
|
|
|
Service Code
|
NDC 50268040115
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.05 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna Commercial |
$175.61
|
| Rate for Payer: Aetna Medicare |
$97.56
|
| Rate for Payer: ASR ASR |
$189.27
|
| Rate for Payer: ASR Commercial |
$189.27
|
| Rate for Payer: BCBS Complete |
$78.05
|
| Rate for Payer: BCBS Trust/PPO |
$159.78
|
| Rate for Payer: BCN Commercial |
$151.28
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$183.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Healthscope Commercial |
$195.12
|
| Rate for Payer: Healthscope Whirlpool |
$189.27
|
| Rate for Payer: Mclaren Commercial |
$175.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.85
|
| Rate for Payer: Nomi Health Commercial |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.96
|
| Rate for Payer: Priority Health Narrow Network |
$136.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.71
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
NDC 00406012362
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Aetna Commercial |
$57.33
|
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: ASR ASR |
$61.79
|
| Rate for Payer: ASR Commercial |
$61.79
|
| Rate for Payer: BCBS Complete |
$25.48
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$49.39
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$59.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$63.70
|
| Rate for Payer: Healthscope Whirlpool |
$61.79
|
| Rate for Payer: Mclaren Commercial |
$57.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.14
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.81
|
| Rate for Payer: Priority Health Narrow Network |
$44.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.06
|
|
|
HYDROCODONE 5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 50268040111
|
| Hospital Charge Code |
34505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: ASR ASR |
$3.78
|
| Rate for Payer: ASR Commercial |
$3.78
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Healthscope Whirlpool |
$3.78
|
| Rate for Payer: Mclaren Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: Nomi Health Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.42
|
| Rate for Payer: Priority Health Narrow Network |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.43
|
|
|
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 |
$5.61 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: ASR ASR |
$8.37
|
| Rate for Payer: ASR Commercial |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$7.03
|
| Rate for Payer: BCN Commercial |
$6.69
|
| 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 |
$8.63
|
| Rate for Payer: Healthscope Whirlpool |
$8.37
|
| Rate for Payer: Mclaren Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.59
|
|
|
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 |
$560.79 |
| Max. Negotiated Rate |
$862.75 |
| Rate for Payer: Aetna Commercial |
$776.48
|
| Rate for Payer: ASR ASR |
$836.87
|
| Rate for Payer: ASR Commercial |
$836.87
|
| Rate for Payer: BCBS Trust/PPO |
$703.05
|
| Rate for Payer: BCN Commercial |
$668.89
|
| Rate for Payer: Cash Price |
$690.20
|
| Rate for Payer: Cofinity Commercial |
$810.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$690.20
|
| Rate for Payer: Healthscope Commercial |
$862.75
|
| Rate for Payer: Healthscope Whirlpool |
$836.87
|
| 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: Priority Health Cigna Priority Health |
$560.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$759.22
|
|
|
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 |
$3.45 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Aetna Commercial |
$7.77
|
| Rate for Payer: Aetna Medicare |
$4.32
|
| Rate for Payer: ASR ASR |
$8.37
|
| Rate for Payer: ASR Commercial |
$8.37
|
| Rate for Payer: BCBS Complete |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.07
|
| Rate for Payer: BCN Commercial |
$6.69
|
| 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 |
$8.63
|
| Rate for Payer: Healthscope Whirlpool |
$8.37
|
| Rate for Payer: Mclaren Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.34
|
| Rate for Payer: Nomi Health Commercial |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.61
|
| Rate for Payer: 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 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 |
$5.94 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Narrow Network |
$10.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
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 |
$6.18 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: Aetna Medicare |
$7.72
|
| Rate for Payer: ASR ASR |
$14.98
|
| Rate for Payer: ASR Commercial |
$14.98
|
| Rate for Payer: BCBS Complete |
$6.18
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.35
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Nomi Health Commercial |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.53
|
| Rate for Payer: Priority Health Narrow Network |
$10.82
|
| 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 09900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: ASR ASR |
$9.82
|
| Rate for Payer: ASR Commercial |
$9.82
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$8.29
|
| Rate for Payer: BCN Commercial |
$7.85
|
| 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 |
$10.12
|
| Rate for Payer: Healthscope Whirlpool |
$9.82
|
| 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: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: 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
|
IP
|
$14.86
|
|
|
Service Code
|
NDC 60687041744
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.11
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
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 |
$10.04 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: ASR ASR |
$14.98
|
| Rate for Payer: ASR Commercial |
$14.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.35
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Nomi Health Commercial |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$15.44
|
|
|
Service Code
|
NDC 66689002301
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: Aetna Commercial |
$13.90
|
| Rate for Payer: ASR ASR |
$14.98
|
| Rate for Payer: ASR Commercial |
$14.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.58
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.35
|
| Rate for Payer: Healthscope Commercial |
$15.44
|
| Rate for Payer: Healthscope Whirlpool |
$14.98
|
| Rate for Payer: Mclaren Commercial |
$13.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Nomi Health Commercial |
$12.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.59
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$42.44
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: ASR Commercial |
$41.17
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$34.75
|
| Rate for Payer: BCN Commercial |
$32.90
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.95
|
| Rate for Payer: Healthscope Commercial |
$42.44
|
| Rate for Payer: Healthscope Whirlpool |
$41.17
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.07
|
| Rate for Payer: Nomi Health Commercial |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: 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
|
|
