Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OXYCODONE 10 MG TABLET

Facility

$4.27

Service Code	NDC 68084-968-11
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$3.84
Rate for Payer: Aetna Commercial	$3.63
Rate for Payer: Aetna New Business (MI Preferred)	$2.78
Rate for Payer: Cash Price	$3.42
Rate for Payer: Cofinity Commercial	$2.99
Rate for Payer: Cofinity Commercial	$3.67
Rate for Payer: Healthscope Commercial	$3.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.63
Rate for Payer: PHP Commercial	$3.63
Rate for Payer: Priority Health Cigna Priority Health	$2.99
Rate for Payer: Priority Health SBD	$2.69

OXYCODONE 15 MG TABLET

Facility

$523.60

Service Code	NDC 0406-8515-62
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$329.87
Max. Negotiated Rate	$471.24
Rate for Payer: Aetna Commercial	$445.06
Rate for Payer: Aetna New Business (MI Preferred)	$340.34
Rate for Payer: Cash Price	$418.88
Rate for Payer: Cofinity Commercial	$450.30
Rate for Payer: Cofinity Commercial	$366.52
Rate for Payer: Healthscope Commercial	$471.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$445.06
Rate for Payer: PHP Commercial	$445.06
Rate for Payer: Priority Health Cigna Priority Health	$366.52
Rate for Payer: Priority Health SBD	$329.87

OXYCODONE 15 MG TABLET

Facility

$5.24

Service Code	NDC 0406-8515-23
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$4.72
Rate for Payer: Aetna Commercial	$4.45
Rate for Payer: Aetna New Business (MI Preferred)	$3.41
Rate for Payer: Cash Price	$4.19
Rate for Payer: Cofinity Commercial	$3.67
Rate for Payer: Cofinity Commercial	$4.51
Rate for Payer: Healthscope Commercial	$4.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.45
Rate for Payer: PHP Commercial	$4.45
Rate for Payer: Priority Health Cigna Priority Health	$3.67
Rate for Payer: Priority Health SBD	$3.30

OXYCODONE 5 MG TABLET

Facility

$148.75

Service Code	NDC 10702-018-01
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$93.71
Max. Negotiated Rate	$133.88
Rate for Payer: Aetna Commercial	$126.44
Rate for Payer: Aetna New Business (MI Preferred)	$96.69
Rate for Payer: Cash Price	$119.00
Rate for Payer: Cofinity Commercial	$104.12
Rate for Payer: Cofinity Commercial	$127.92
Rate for Payer: Healthscope Commercial	$133.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$126.44
Rate for Payer: PHP Commercial	$126.44
Rate for Payer: Priority Health Cigna Priority Health	$104.12
Rate for Payer: Priority Health SBD	$93.71

OXYCODONE 5 MG TABLET

Facility

$5.81

Service Code	NDC 0406-0552-23
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna New Business (MI Preferred)	$3.78
Rate for Payer: BCBS Complete	$2.32
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cofinity Commercial	$4.07
Rate for Payer: Cofinity Commercial	$5.00
Rate for Payer: Healthscope Commercial	$5.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.94
Rate for Payer: PHP Commercial	$4.94
Rate for Payer: Priority Health Cigna Priority Health	$4.07
Rate for Payer: Priority Health SBD	$3.66

OXYCODONE 5 MG TABLET

Facility

$119.00

Service Code	NDC 42858-001-01
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$74.97
Max. Negotiated Rate	$107.10
Rate for Payer: Aetna Commercial	$101.15
Rate for Payer: Aetna New Business (MI Preferred)	$77.35
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cofinity Commercial	$102.34
Rate for Payer: Cofinity Commercial	$83.30
Rate for Payer: Healthscope Commercial	$107.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$101.15
Rate for Payer: PHP Commercial	$101.15
Rate for Payer: Priority Health Cigna Priority Health	$83.30
Rate for Payer: Priority Health SBD	$74.97

OXYCODONE 5 MG TABLET

Facility

$5.81

Service Code	NDC 0406-0552-23
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna New Business (MI Preferred)	$3.78
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cofinity Commercial	$4.07
Rate for Payer: Cofinity Commercial	$5.00
Rate for Payer: Healthscope Commercial	$5.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.94
Rate for Payer: PHP Commercial	$4.94
Rate for Payer: Priority Health Cigna Priority Health	$4.07
Rate for Payer: Priority Health SBD	$3.66

OXYCODONE 5 MG TABLET

Facility

$635.25

Service Code	NDC 68084-354-11
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$400.21
Max. Negotiated Rate	$571.72
Rate for Payer: Aetna Commercial	$539.96
Rate for Payer: Aetna New Business (MI Preferred)	$412.91
Rate for Payer: Cash Price	$508.20
Rate for Payer: Cofinity Commercial	$444.68
Rate for Payer: Cofinity Commercial	$546.32
Rate for Payer: Healthscope Commercial	$571.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$539.96
Rate for Payer: PHP Commercial	$539.96
Rate for Payer: Priority Health Cigna Priority Health	$444.68
Rate for Payer: Priority Health SBD	$400.21

OXYCODONE 5 MG TABLET

Facility

$238.00

Service Code	NDC 57664-223-88
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna Commercial	$202.30
Rate for Payer: Aetna New Business (MI Preferred)	$154.70
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cofinity Commercial	$166.60
Rate for Payer: Cofinity Commercial	$204.68
Rate for Payer: Healthscope Commercial	$214.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$202.30
Rate for Payer: PHP Commercial	$202.30
Rate for Payer: Priority Health Cigna Priority Health	$166.60
Rate for Payer: Priority Health SBD	$149.94

OXYCODONE 5 MG TABLET

Facility

$581.00

Service Code	NDC 0406-0552-62
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$366.03
Max. Negotiated Rate	$522.90
Rate for Payer: Aetna Commercial	$493.85
Rate for Payer: Aetna New Business (MI Preferred)	$377.65
Rate for Payer: Cash Price	$464.80
Rate for Payer: Cofinity Commercial	$406.70
Rate for Payer: Cofinity Commercial	$499.66
Rate for Payer: Healthscope Commercial	$522.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$493.85
Rate for Payer: PHP Commercial	$493.85
Rate for Payer: Priority Health Cigna Priority Health	$406.70
Rate for Payer: Priority Health SBD	$366.03

OXYCODONE 5 MG TABLET

Facility

$680.75

Service Code	NDC 42858-001-10
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$428.87
Max. Negotiated Rate	$612.68
Rate for Payer: Aetna Commercial	$578.64
Rate for Payer: Aetna New Business (MI Preferred)	$442.49
Rate for Payer: Cash Price	$544.60
Rate for Payer: Cofinity Commercial	$476.52
Rate for Payer: Cofinity Commercial	$585.44
Rate for Payer: Healthscope Commercial	$612.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$578.64
Rate for Payer: PHP Commercial	$578.64
Rate for Payer: Priority Health Cigna Priority Health	$476.52
Rate for Payer: Priority Health SBD	$428.87

OXYCODONE 5 MG TABLET

Facility

$171.50

Service Code	NDC 65162-047-10
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$108.04
Max. Negotiated Rate	$154.35
Rate for Payer: Aetna Commercial	$145.78
Rate for Payer: Aetna New Business (MI Preferred)	$111.48
Rate for Payer: Cash Price	$137.20
Rate for Payer: Cofinity Commercial	$120.05
Rate for Payer: Cofinity Commercial	$147.49
Rate for Payer: Healthscope Commercial	$154.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$145.78
Rate for Payer: PHP Commercial	$145.78
Rate for Payer: Priority Health Cigna Priority Health	$120.05
Rate for Payer: Priority Health SBD	$108.04

OXYCODONE 5 MG TABLET

Facility

$581.00

Service Code	NDC 0406-0552-62
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$522.90
Rate for Payer: Aetna Commercial	$493.85
Rate for Payer: Aetna New Business (MI Preferred)	$377.65
Rate for Payer: BCBS Complete	$232.40
Rate for Payer: Cash Price	$464.80
Rate for Payer: Cofinity Commercial	$406.70
Rate for Payer: Cofinity Commercial	$499.66
Rate for Payer: Healthscope Commercial	$522.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$493.85
Rate for Payer: PHP Commercial	$493.85
Rate for Payer: Priority Health Cigna Priority Health	$406.70
Rate for Payer: Priority Health SBD	$366.03

OXYCODONE 5 MG TABLET

Facility

$432.25

Service Code	NDC 0904-6966-61
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$272.32
Max. Negotiated Rate	$389.02
Rate for Payer: Aetna Commercial	$367.41
Rate for Payer: Aetna New Business (MI Preferred)	$280.96
Rate for Payer: Cash Price	$345.80
Rate for Payer: Cofinity Commercial	$302.58
Rate for Payer: Cofinity Commercial	$371.74
Rate for Payer: Healthscope Commercial	$389.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$367.41
Rate for Payer: PHP Commercial	$367.41
Rate for Payer: Priority Health Cigna Priority Health	$302.58
Rate for Payer: Priority Health SBD	$272.32

OXYCODONE 5 MG TABLET

Facility

$635.25

Service Code	NDC 68084-354-01
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$400.21
Max. Negotiated Rate	$571.72
Rate for Payer: Aetna Commercial	$539.96
Rate for Payer: Aetna New Business (MI Preferred)	$412.91
Rate for Payer: Cash Price	$508.20
Rate for Payer: Cofinity Commercial	$444.68
Rate for Payer: Cofinity Commercial	$546.32
Rate for Payer: Healthscope Commercial	$571.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$539.96
Rate for Payer: PHP Commercial	$539.96
Rate for Payer: Priority Health Cigna Priority Health	$444.68
Rate for Payer: Priority Health SBD	$400.21

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$1,026.20

Service Code	NDC 68084-710-01
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$410.48
Max. Negotiated Rate	$923.58
Rate for Payer: Aetna Commercial	$872.27
Rate for Payer: Aetna New Business (MI Preferred)	$667.03
Rate for Payer: BCBS Complete	$410.48
Rate for Payer: Cash Price	$820.96
Rate for Payer: Cofinity Commercial	$718.34
Rate for Payer: Cofinity Commercial	$882.53
Rate for Payer: Healthscope Commercial	$923.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$872.27
Rate for Payer: PHP Commercial	$872.27
Rate for Payer: Priority Health Cigna Priority Health	$718.34
Rate for Payer: Priority Health SBD	$646.51

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$10.27

Service Code	NDC 68084-710-11
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$9.24
Rate for Payer: Aetna Commercial	$8.73
Rate for Payer: Aetna New Business (MI Preferred)	$6.68
Rate for Payer: BCBS Complete	$4.11
Rate for Payer: Cash Price	$8.22
Rate for Payer: Cofinity Commercial	$7.19
Rate for Payer: Cofinity Commercial	$8.83
Rate for Payer: Healthscope Commercial	$9.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.73
Rate for Payer: PHP Commercial	$8.73
Rate for Payer: Priority Health Cigna Priority Health	$7.19
Rate for Payer: Priority Health SBD	$6.47

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$1,305.50

Service Code	NDC 0406-0523-62
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$822.46
Max. Negotiated Rate	$1,174.95
Rate for Payer: Aetna Commercial	$1,109.68
Rate for Payer: Aetna New Business (MI Preferred)	$848.58
Rate for Payer: Cash Price	$1,044.40
Rate for Payer: Cofinity Commercial	$1,122.73
Rate for Payer: Cofinity Commercial	$913.85
Rate for Payer: Healthscope Commercial	$1,174.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,109.68
Rate for Payer: PHP Commercial	$1,109.68
Rate for Payer: Priority Health Cigna Priority Health	$913.85
Rate for Payer: Priority Health SBD	$822.46

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$753.20

Service Code	NDC 0904-7095-61
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$474.52
Max. Negotiated Rate	$677.88
Rate for Payer: Aetna Commercial	$640.22
Rate for Payer: Aetna New Business (MI Preferred)	$489.58
Rate for Payer: Cash Price	$602.56
Rate for Payer: Cofinity Commercial	$527.24
Rate for Payer: Cofinity Commercial	$647.75
Rate for Payer: Healthscope Commercial	$677.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$640.22
Rate for Payer: PHP Commercial	$640.22
Rate for Payer: Priority Health Cigna Priority Health	$527.24
Rate for Payer: Priority Health SBD	$474.52

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$10.27

Service Code	NDC 68084-710-11
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$6.47
Max. Negotiated Rate	$9.24
Rate for Payer: Aetna Commercial	$8.73
Rate for Payer: Aetna New Business (MI Preferred)	$6.68
Rate for Payer: Cash Price	$8.22
Rate for Payer: Cofinity Commercial	$7.19
Rate for Payer: Cofinity Commercial	$8.83
Rate for Payer: Healthscope Commercial	$9.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.73
Rate for Payer: PHP Commercial	$8.73
Rate for Payer: Priority Health Cigna Priority Health	$7.19
Rate for Payer: Priority Health SBD	$6.47

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$1,026.20

Service Code	NDC 68084-710-01
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$646.51
Max. Negotiated Rate	$923.58
Rate for Payer: Aetna Commercial	$872.27
Rate for Payer: Aetna New Business (MI Preferred)	$667.03
Rate for Payer: Cash Price	$820.96
Rate for Payer: Cofinity Commercial	$718.34
Rate for Payer: Cofinity Commercial	$882.53
Rate for Payer: Healthscope Commercial	$923.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$872.27
Rate for Payer: PHP Commercial	$872.27
Rate for Payer: Priority Health Cigna Priority Health	$718.34
Rate for Payer: Priority Health SBD	$646.51

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$13.06

Service Code	NDC 0406-0523-23
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$11.75
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna New Business (MI Preferred)	$8.49
Rate for Payer: Cash Price	$10.45
Rate for Payer: Cofinity Commercial	$11.23
Rate for Payer: Cofinity Commercial	$9.14
Rate for Payer: Healthscope Commercial	$11.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.10
Rate for Payer: PHP Commercial	$11.10
Rate for Payer: Priority Health Cigna Priority Health	$9.14
Rate for Payer: Priority Health SBD	$8.23

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$70.00

Service Code	NDC 0406-0512-62
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$44.10
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$59.50
Rate for Payer: Aetna New Business (MI Preferred)	$45.50
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cofinity Commercial	$49.00
Rate for Payer: Cofinity Commercial	$60.20
Rate for Payer: Healthscope Commercial	$63.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.50
Rate for Payer: PHP Commercial	$59.50
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health SBD	$44.10

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$637.00

Service Code	NDC 68084-355-01
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$401.31
Max. Negotiated Rate	$573.30
Rate for Payer: Aetna Commercial	$541.45
Rate for Payer: Aetna New Business (MI Preferred)	$414.05
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cofinity Commercial	$445.90
Rate for Payer: Cofinity Commercial	$547.82
Rate for Payer: Healthscope Commercial	$573.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$541.45
Rate for Payer: PHP Commercial	$541.45
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health SBD	$401.31

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$7.00

Service Code	NDC 0406-0512-23
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna Commercial	$5.95
Rate for Payer: Aetna New Business (MI Preferred)	$4.55
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cofinity Commercial	$4.90
Rate for Payer: Cofinity Commercial	$6.02
Rate for Payer: Healthscope Commercial	$6.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.95
Rate for Payer: PHP Commercial	$5.95
Rate for Payer: Priority Health Cigna Priority Health	$4.90
Rate for Payer: Priority Health SBD	$4.41

Know your out-of-pocket cost for care.

All Charges