|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$231.65
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Commercial |
$242.56
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna Medicare |
$115.83
|
| Rate for Payer: Aetna Medicare |
$142.68
|
| Rate for Payer: Aetna Medicare |
$450.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: BCBS Complete |
$360.75
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: BCBS Complete |
$114.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cofinity Advantage |
$199.75
|
| Rate for Payer: Cofinity Advantage |
$162.16
|
| Rate for Payer: Cofinity Advantage |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Commercial |
$245.41
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Healthscope Commercial |
$256.82
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$676.41
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$242.56
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: Priority Health SBD |
$179.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
OXALIPLATIN 100 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.36
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
99612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$256.82 |
| Rate for Payer: Aetna Commercial |
$242.56
|
| Rate for Payer: Aetna Commercial |
$196.90
|
| Rate for Payer: Aetna Commercial |
$766.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.57
|
| Rate for Payer: Cash Price |
$721.50
|
| Rate for Payer: Cash Price |
$228.29
|
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Cofinity Advantage |
$199.75
|
| Rate for Payer: Cofinity Advantage |
$162.16
|
| Rate for Payer: Cofinity Advantage |
$631.32
|
| Rate for Payer: Cofinity Commercial |
$775.62
|
| Rate for Payer: Cofinity Commercial |
$199.22
|
| Rate for Payer: Cofinity Commercial |
$245.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.50
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Healthscope Commercial |
$256.82
|
| Rate for Payer: Healthscope Commercial |
$811.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$766.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$676.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.02
|
| Rate for Payer: PHP Commercial |
$196.90
|
| Rate for Payer: PHP Commercial |
$766.60
|
| Rate for Payer: PHP Commercial |
$242.56
|
| Rate for Payer: Priority Health SBD |
$568.18
|
| Rate for Payer: Priority Health SBD |
$145.94
|
| Rate for Payer: Priority Health SBD |
$179.78
|
|
|
OXALIPLATIN 50 MG/10 ML (5 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$261.63
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
41598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$235.47 |
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$226.87
|
| Rate for Payer: Aetna Commercial |
$405.14
|
| Rate for Payer: Aetna Commercial |
$115.88
|
| Rate for Payer: Aetna Commercial |
$243.08
|
| Rate for Payer: Aetna Commercial |
$381.17
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: Aetna Medicare |
$224.22
|
| Rate for Payer: Aetna Medicare |
$238.31
|
| Rate for Payer: Aetna Medicare |
$142.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.49
|
| Rate for Payer: BCBS Complete |
$106.76
|
| Rate for Payer: BCBS Complete |
$190.65
|
| Rate for Payer: BCBS Complete |
$179.38
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$54.53
|
| Rate for Payer: BCBS Complete |
$114.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: Cash Price |
$358.75
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$109.06
|
| Rate for Payer: Cash Price |
$109.06
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$213.53
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cash Price |
$358.75
|
| Rate for Payer: Cash Price |
$381.30
|
| Rate for Payer: Cash Price |
$228.78
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cofinity Advantage |
$95.43
|
| Rate for Payer: Cofinity Advantage |
$313.91
|
| Rate for Payer: Cofinity Advantage |
$200.19
|
| Rate for Payer: Cofinity Advantage |
$333.64
|
| Rate for Payer: Cofinity Advantage |
$186.84
|
| Rate for Payer: Cofinity Advantage |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$229.54
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$117.24
|
| Rate for Payer: Cofinity Commercial |
$409.90
|
| Rate for Payer: Cofinity Commercial |
$245.94
|
| Rate for Payer: Cofinity Commercial |
$385.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.75
|
| Rate for Payer: Healthscope Commercial |
$428.97
|
| Rate for Payer: Healthscope Commercial |
$403.60
|
| Rate for Payer: Healthscope Commercial |
$257.38
|
| Rate for Payer: Healthscope Commercial |
$240.22
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Commercial |
$122.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.47
|
| Rate for Payer: PHP Commercial |
$243.08
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: PHP Commercial |
$226.87
|
| Rate for Payer: PHP Commercial |
$115.88
|
| Rate for Payer: PHP Commercial |
$405.14
|
| Rate for Payer: PHP Commercial |
$381.17
|
| Rate for Payer: Priority Health SBD |
$282.52
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$300.28
|
| Rate for Payer: Priority Health SBD |
$180.17
|
| Rate for Payer: Priority Health SBD |
$168.15
|
| Rate for Payer: Priority Health SBD |
$85.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$3.99
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.07 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.43
|
| Rate for Payer: UHC Core |
$175.08
|
| Rate for Payer: UHC Exchange |
$132.07
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$3.99
|
|
|
Service Code
|
NDC 68084084511
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Advantage |
$2.79
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.99
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health SBD |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.08
|
| Rate for Payer: UHC Exchange |
$1.57
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 51991029201
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.71 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
NDC 68084084501
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.81 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna Medicare |
$199.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: BCBS Complete |
$159.60
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Advantage |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health SBD |
$251.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.35
|
| Rate for Payer: UHC Core |
$207.88
|
| Rate for Payer: UHC Exchange |
$156.81
|
|
|
OXCARBAZEPINE 150 MG TABLET
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
NDC 68084084501
|
| Hospital Charge Code |
27049
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$359.10 |
| Rate for Payer: Aetna Commercial |
$339.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.35
|
| Rate for Payer: Cash Price |
$319.20
|
| Rate for Payer: Cofinity Advantage |
$279.30
|
| Rate for Payer: Cofinity Commercial |
$343.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.20
|
| Rate for Payer: Healthscope Commercial |
$359.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.25
|
| Rate for Payer: PHP Commercial |
$339.15
|
| Rate for Payer: Priority Health SBD |
$251.37
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.33 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna Medicare |
$149.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: BCBS Complete |
$119.42
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Advantage |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health SBD |
$188.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.06
|
| Rate for Payer: UHC Core |
$155.55
|
| Rate for Payer: UHC Exchange |
$117.33
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$404.16
|
|
|
Service Code
|
NDC 60687072201
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.62 |
| Max. Negotiated Rate |
$363.74 |
| Rate for Payer: Aetna Commercial |
$343.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.70
|
| Rate for Payer: Cash Price |
$323.33
|
| Rate for Payer: Cofinity Advantage |
$282.91
|
| Rate for Payer: Cofinity Commercial |
$347.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.33
|
| Rate for Payer: Healthscope Commercial |
$363.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.12
|
| Rate for Payer: PHP Commercial |
$343.54
|
| Rate for Payer: Priority Health SBD |
$254.62
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$404.16
|
|
|
Service Code
|
NDC 60687072201
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.83 |
| Max. Negotiated Rate |
$363.74 |
| Rate for Payer: Aetna Commercial |
$343.54
|
| Rate for Payer: Aetna Medicare |
$202.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.70
|
| Rate for Payer: BCBS Complete |
$161.66
|
| Rate for Payer: Cash Price |
$323.33
|
| Rate for Payer: Cofinity Advantage |
$282.91
|
| Rate for Payer: Cofinity Commercial |
$347.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.33
|
| Rate for Payer: Healthscope Commercial |
$363.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.12
|
| Rate for Payer: PHP Commercial |
$343.54
|
| Rate for Payer: Priority Health SBD |
$254.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.70
|
| Rate for Payer: UHC Core |
$210.57
|
| Rate for Payer: UHC Exchange |
$158.83
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Advantage |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health SBD |
$1.88
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$267.97 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Advantage |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health SBD |
$267.97
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.09 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.06
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Advantage |
$208.99
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health SBD |
$188.09
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687072211
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: BCBS Complete |
$170.14
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Advantage |
$297.75
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.48
|
| Rate for Payer: UHC Core |
$221.61
|
| Rate for Payer: UHC Exchange |
$167.16
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 60687072211
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Advantage |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.04
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.11
|
| Rate for Payer: UHC Exchange |
$1.59
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Advantage |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.18
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 52817026010
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Advantage |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.12
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health SBD |
$74.03
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 52817026010
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.18 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: BCBS Complete |
$47.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Advantage |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.12
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.38
|
| Rate for Payer: UHC Core |
$61.22
|
| Rate for Payer: UHC Exchange |
$46.18
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
NDC 50268062811
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.45
|
| Rate for Payer: BCBS Complete |
$3.97
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cofinity Advantage |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$8.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.44
|
| Rate for Payer: PHP Commercial |
$8.43
|
| Rate for Payer: Priority Health SBD |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.45
|
| Rate for Payer: UHC Core |
$5.17
|
| Rate for Payer: UHC Exchange |
$3.90
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$495.80
|
|
|
Service Code
|
NDC 50268062815
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.35 |
| Max. Negotiated Rate |
$446.22 |
| Rate for Payer: Aetna Commercial |
$421.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.27
|
| Rate for Payer: Cash Price |
$396.64
|
| Rate for Payer: Cofinity Advantage |
$347.06
|
| Rate for Payer: Cofinity Commercial |
$426.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.64
|
| Rate for Payer: Healthscope Commercial |
$446.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.85
|
| Rate for Payer: PHP Commercial |
$421.43
|
| Rate for Payer: Priority Health SBD |
$312.35
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$9.92
|
|
|
Service Code
|
NDC 50268062811
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.45
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cofinity Advantage |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$8.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.44
|
| Rate for Payer: PHP Commercial |
$8.43
|
| Rate for Payer: Priority Health SBD |
$6.25
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$495.80
|
|
|
Service Code
|
NDC 50268062815
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.85 |
| Max. Negotiated Rate |
$446.22 |
| Rate for Payer: Aetna Commercial |
$421.43
|
| Rate for Payer: Aetna Medicare |
$247.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.27
|
| Rate for Payer: BCBS Complete |
$198.32
|
| Rate for Payer: Cash Price |
$396.64
|
| Rate for Payer: Cofinity Advantage |
$347.06
|
| Rate for Payer: Cofinity Commercial |
$426.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.64
|
| Rate for Payer: Healthscope Commercial |
$446.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.85
|
| Rate for Payer: PHP Commercial |
$421.43
|
| Rate for Payer: Priority Health SBD |
$312.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.27
|
| Rate for Payer: UHC Core |
$258.31
|
| Rate for Payer: UHC Exchange |
$194.85
|
|
