Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$329.00

Service Code	NDC 64980020901
Hospital Charge Code	24470
Hospital Revenue Code	637
Min. Negotiated Rate	$129.30
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: BCBS Complete	$131.60
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Advantage	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: MI Amish Medical Board Commercial	$263.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health SBD	$207.27
Rate for Payer: UHC All Payor (Choice/PPO)	$213.85
Rate for Payer: UHC Core	$171.41
Rate for Payer: UHC Exchange	$129.30

OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$329.00

Service Code	NDC 64980020901
Hospital Charge Code	24470
Hospital Revenue Code	637
Min. Negotiated Rate	$207.27
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Advantage	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health SBD	$207.27

OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$285.60

Service Code	NDC 00904657006
Hospital Charge Code	24470
Hospital Revenue Code	637
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$257.04
Rate for Payer: Aetna Commercial	$242.76
Rate for Payer: Aetna New Business (MI Preferred)	$185.64
Rate for Payer: Cash Price	$228.48
Rate for Payer: Cofinity Advantage	$199.92
Rate for Payer: Cofinity Commercial	$245.62
Rate for Payer: Encore Health Key Benefits Commercial	$228.48
Rate for Payer: Healthscope Commercial	$257.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.20
Rate for Payer: PHP Commercial	$242.76
Rate for Payer: Priority Health SBD	$179.93

OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$285.60

Service Code	NDC 00904657006
Hospital Charge Code	24470
Hospital Revenue Code	637
Min. Negotiated Rate	$112.24
Max. Negotiated Rate	$257.04
Rate for Payer: Aetna Commercial	$242.76
Rate for Payer: Aetna Medicare	$142.80
Rate for Payer: Aetna New Business (MI Preferred)	$185.64
Rate for Payer: BCBS Complete	$114.24
Rate for Payer: Cash Price	$228.48
Rate for Payer: Cofinity Advantage	$199.92
Rate for Payer: Cofinity Commercial	$245.62
Rate for Payer: Encore Health Key Benefits Commercial	$228.48
Rate for Payer: Healthscope Commercial	$257.04
Rate for Payer: MI Amish Medical Board Commercial	$228.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.20
Rate for Payer: PHP Commercial	$242.76
Rate for Payer: Priority Health SBD	$179.93
Rate for Payer: UHC All Payor (Choice/PPO)	$185.64
Rate for Payer: UHC Core	$148.80
Rate for Payer: UHC Exchange	$112.24

OXYCODONE 10 MG TABLET

Facility

$267.75

Service Code	NDC 10702005601
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$105.23
Max. Negotiated Rate	$240.97
Rate for Payer: Aetna Commercial	$227.59
Rate for Payer: Aetna Medicare	$133.88
Rate for Payer: Aetna New Business (MI Preferred)	$174.04
Rate for Payer: BCBS Complete	$107.10
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cofinity Advantage	$187.43
Rate for Payer: Cofinity Commercial	$230.26
Rate for Payer: Encore Health Key Benefits Commercial	$214.20
Rate for Payer: Healthscope Commercial	$240.97
Rate for Payer: MI Amish Medical Board Commercial	$214.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.81
Rate for Payer: PHP Commercial	$227.59
Rate for Payer: Priority Health SBD	$168.68
Rate for Payer: UHC All Payor (Choice/PPO)	$174.04
Rate for Payer: UHC Core	$139.50
Rate for Payer: UHC Exchange	$105.23

OXYCODONE 10 MG TABLET

Facility

$619.50

Service Code	NDC 68084096801
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$390.29
Max. Negotiated Rate	$557.55
Rate for Payer: Aetna Commercial	$526.58
Rate for Payer: Aetna New Business (MI Preferred)	$402.68
Rate for Payer: Cash Price	$495.60
Rate for Payer: Cofinity Advantage	$433.65
Rate for Payer: Cofinity Commercial	$532.77
Rate for Payer: Encore Health Key Benefits Commercial	$495.60
Rate for Payer: Healthscope Commercial	$557.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$464.62
Rate for Payer: PHP Commercial	$526.58
Rate for Payer: Priority Health SBD	$390.29

OXYCODONE 10 MG TABLET

Facility

$6.20

Service Code	NDC 68084096811
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.58
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna Medicare	$3.10
Rate for Payer: Aetna New Business (MI Preferred)	$4.03
Rate for Payer: BCBS Complete	$2.48
Rate for Payer: Cash Price	$4.96
Rate for Payer: Cofinity Advantage	$4.34
Rate for Payer: Cofinity Commercial	$5.33
Rate for Payer: Encore Health Key Benefits Commercial	$4.96
Rate for Payer: Healthscope Commercial	$5.58
Rate for Payer: MI Amish Medical Board Commercial	$4.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.65
Rate for Payer: PHP Commercial	$5.27
Rate for Payer: Priority Health SBD	$3.91
Rate for Payer: UHC All Payor (Choice/PPO)	$4.03
Rate for Payer: UHC Core	$3.23
Rate for Payer: UHC Exchange	$2.44

OXYCODONE 10 MG TABLET

Facility

$267.75

Service Code	NDC 10702005601
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$168.68
Max. Negotiated Rate	$240.97
Rate for Payer: Aetna Commercial	$227.59
Rate for Payer: Aetna New Business (MI Preferred)	$174.04
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cofinity Advantage	$187.43
Rate for Payer: Cofinity Commercial	$230.26
Rate for Payer: Encore Health Key Benefits Commercial	$214.20
Rate for Payer: Healthscope Commercial	$240.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.81
Rate for Payer: PHP Commercial	$227.59
Rate for Payer: Priority Health SBD	$168.68

OXYCODONE 10 MG TABLET

Facility

$6.20

Service Code	NDC 68084096811
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$5.58
Rate for Payer: Aetna Commercial	$5.27
Rate for Payer: Aetna New Business (MI Preferred)	$4.03
Rate for Payer: Cash Price	$4.96
Rate for Payer: Cofinity Advantage	$4.34
Rate for Payer: Cofinity Commercial	$5.33
Rate for Payer: Encore Health Key Benefits Commercial	$4.96
Rate for Payer: Healthscope Commercial	$5.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.65
Rate for Payer: PHP Commercial	$5.27
Rate for Payer: Priority Health SBD	$3.91

OXYCODONE 10 MG TABLET

Facility

$619.50

Service Code	NDC 68084096801
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$243.46
Max. Negotiated Rate	$557.55
Rate for Payer: Aetna Commercial	$526.58
Rate for Payer: Aetna Medicare	$309.75
Rate for Payer: Aetna New Business (MI Preferred)	$402.68
Rate for Payer: BCBS Complete	$247.80
Rate for Payer: Cash Price	$495.60
Rate for Payer: Cofinity Advantage	$433.65
Rate for Payer: Cofinity Commercial	$532.77
Rate for Payer: Encore Health Key Benefits Commercial	$495.60
Rate for Payer: Healthscope Commercial	$557.55
Rate for Payer: MI Amish Medical Board Commercial	$495.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$464.62
Rate for Payer: PHP Commercial	$526.58
Rate for Payer: Priority Health SBD	$390.29
Rate for Payer: UHC All Payor (Choice/PPO)	$402.68
Rate for Payer: UHC Core	$322.76
Rate for Payer: UHC Exchange	$243.46

OXYCODONE 15 MG TABLET

Facility

$650.30

Service Code	NDC 00406851562
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$409.69
Max. Negotiated Rate	$585.27
Rate for Payer: Aetna Commercial	$552.75
Rate for Payer: Aetna New Business (MI Preferred)	$422.69
Rate for Payer: Cash Price	$520.24
Rate for Payer: Cofinity Advantage	$455.21
Rate for Payer: Cofinity Commercial	$559.26
Rate for Payer: Encore Health Key Benefits Commercial	$520.24
Rate for Payer: Healthscope Commercial	$585.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$552.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$487.73
Rate for Payer: PHP Commercial	$552.75
Rate for Payer: Priority Health SBD	$409.69

OXYCODONE 15 MG TABLET

Facility

$6.51

Service Code	NDC 00406851523
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$5.86
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna New Business (MI Preferred)	$4.23
Rate for Payer: Cash Price	$5.21
Rate for Payer: Cofinity Advantage	$4.56
Rate for Payer: Cofinity Commercial	$5.60
Rate for Payer: Encore Health Key Benefits Commercial	$5.21
Rate for Payer: Healthscope Commercial	$5.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.88
Rate for Payer: PHP Commercial	$5.53
Rate for Payer: Priority Health SBD	$4.10

OXYCODONE 15 MG TABLET

Facility

$6.51

Service Code	NDC 00406851523
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$5.86
Rate for Payer: Aetna Commercial	$5.53
Rate for Payer: Aetna Medicare	$3.25
Rate for Payer: Aetna New Business (MI Preferred)	$4.23
Rate for Payer: BCBS Complete	$2.60
Rate for Payer: Cash Price	$5.21
Rate for Payer: Cofinity Advantage	$4.56
Rate for Payer: Cofinity Commercial	$5.60
Rate for Payer: Encore Health Key Benefits Commercial	$5.21
Rate for Payer: Healthscope Commercial	$5.86
Rate for Payer: MI Amish Medical Board Commercial	$5.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.88
Rate for Payer: PHP Commercial	$5.53
Rate for Payer: Priority Health SBD	$4.10
Rate for Payer: UHC All Payor (Choice/PPO)	$4.23
Rate for Payer: UHC Core	$3.39
Rate for Payer: UHC Exchange	$2.56

OXYCODONE 15 MG TABLET

Facility

$650.30

Service Code	NDC 00406851562
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$255.57
Max. Negotiated Rate	$585.27
Rate for Payer: Aetna Commercial	$552.75
Rate for Payer: Aetna Medicare	$325.15
Rate for Payer: Aetna New Business (MI Preferred)	$422.69
Rate for Payer: BCBS Complete	$260.12
Rate for Payer: Cash Price	$520.24
Rate for Payer: Cofinity Advantage	$455.21
Rate for Payer: Cofinity Commercial	$559.26
Rate for Payer: Encore Health Key Benefits Commercial	$520.24
Rate for Payer: Healthscope Commercial	$585.27
Rate for Payer: MI Amish Medical Board Commercial	$520.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$552.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$487.73
Rate for Payer: PHP Commercial	$552.75
Rate for Payer: Priority Health SBD	$409.69
Rate for Payer: UHC All Payor (Choice/PPO)	$422.69
Rate for Payer: UHC Core	$338.81
Rate for Payer: UHC Exchange	$255.57

OXYCODONE 5 MG TABLET

Facility

$792.75

Service Code	NDC 00406055262
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$311.55
Max. Negotiated Rate	$713.48
Rate for Payer: Aetna Commercial	$673.84
Rate for Payer: Aetna Medicare	$396.38
Rate for Payer: Aetna New Business (MI Preferred)	$515.29
Rate for Payer: BCBS Complete	$317.10
Rate for Payer: Cash Price	$634.20
Rate for Payer: Cofinity Advantage	$554.92
Rate for Payer: Cofinity Commercial	$681.76
Rate for Payer: Encore Health Key Benefits Commercial	$634.20
Rate for Payer: Healthscope Commercial	$713.48
Rate for Payer: MI Amish Medical Board Commercial	$634.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$673.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$594.56
Rate for Payer: PHP Commercial	$673.84
Rate for Payer: Priority Health SBD	$499.43
Rate for Payer: UHC All Payor (Choice/PPO)	$515.29
Rate for Payer: UHC Core	$413.02
Rate for Payer: UHC Exchange	$311.55

OXYCODONE 5 MG TABLET

Facility

$610.75

Service Code	NDC 68084035401
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$384.77
Max. Negotiated Rate	$549.67
Rate for Payer: Aetna Commercial	$519.14
Rate for Payer: Aetna New Business (MI Preferred)	$396.99
Rate for Payer: Cash Price	$488.60
Rate for Payer: Cofinity Advantage	$427.52
Rate for Payer: Cofinity Commercial	$525.25
Rate for Payer: Encore Health Key Benefits Commercial	$488.60
Rate for Payer: Healthscope Commercial	$549.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$519.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$458.06
Rate for Payer: PHP Commercial	$519.14
Rate for Payer: Priority Health SBD	$384.77

OXYCODONE 5 MG TABLET

Facility

$238.00

Service Code	NDC 57664022388
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$93.53
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna Commercial	$202.30
Rate for Payer: Aetna Medicare	$119.00
Rate for Payer: Aetna New Business (MI Preferred)	$154.70
Rate for Payer: BCBS Complete	$95.20
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cofinity Advantage	$166.60
Rate for Payer: Cofinity Commercial	$204.68
Rate for Payer: Encore Health Key Benefits Commercial	$190.40
Rate for Payer: Healthscope Commercial	$214.20
Rate for Payer: MI Amish Medical Board Commercial	$190.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.50
Rate for Payer: PHP Commercial	$202.30
Rate for Payer: Priority Health SBD	$149.94
Rate for Payer: UHC All Payor (Choice/PPO)	$154.70
Rate for Payer: UHC Core	$124.00
Rate for Payer: UHC Exchange	$93.53

OXYCODONE 5 MG TABLET

Facility

$484.75

Service Code	NDC 00904696661
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$190.51
Max. Negotiated Rate	$436.27
Rate for Payer: Aetna Commercial	$412.04
Rate for Payer: Aetna Medicare	$242.38
Rate for Payer: Aetna New Business (MI Preferred)	$315.09
Rate for Payer: BCBS Complete	$193.90
Rate for Payer: Cash Price	$387.80
Rate for Payer: Cofinity Advantage	$339.32
Rate for Payer: Cofinity Commercial	$416.88
Rate for Payer: Encore Health Key Benefits Commercial	$387.80
Rate for Payer: Healthscope Commercial	$436.27
Rate for Payer: MI Amish Medical Board Commercial	$387.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$412.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$363.56
Rate for Payer: PHP Commercial	$412.04
Rate for Payer: Priority Health SBD	$305.39
Rate for Payer: UHC All Payor (Choice/PPO)	$315.09
Rate for Payer: UHC Core	$252.55
Rate for Payer: UHC Exchange	$190.51

OXYCODONE 5 MG TABLET

Facility

$610.75

Service Code	NDC 68084035401
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$240.02
Max. Negotiated Rate	$549.67
Rate for Payer: Aetna Commercial	$519.14
Rate for Payer: Aetna Medicare	$305.38
Rate for Payer: Aetna New Business (MI Preferred)	$396.99
Rate for Payer: BCBS Complete	$244.30
Rate for Payer: Cash Price	$488.60
Rate for Payer: Cofinity Advantage	$427.52
Rate for Payer: Cofinity Commercial	$525.25
Rate for Payer: Encore Health Key Benefits Commercial	$488.60
Rate for Payer: Healthscope Commercial	$549.67
Rate for Payer: MI Amish Medical Board Commercial	$488.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$519.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$458.06
Rate for Payer: PHP Commercial	$519.14
Rate for Payer: Priority Health SBD	$384.77
Rate for Payer: UHC All Payor (Choice/PPO)	$396.99
Rate for Payer: UHC Core	$318.20
Rate for Payer: UHC Exchange	$240.02

OXYCODONE 5 MG TABLET

Facility

$238.00

Service Code	NDC 57664022388
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 Advantage	$166.60
Rate for Payer: Cofinity Commercial	$204.68
Rate for Payer: Encore Health Key Benefits Commercial	$190.40
Rate for Payer: Healthscope Commercial	$214.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.50
Rate for Payer: PHP Commercial	$202.30
Rate for Payer: Priority Health SBD	$149.94

OXYCODONE 5 MG TABLET

Facility

$7.93

Service Code	NDC 406055223
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$7.14
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$5.15
Rate for Payer: BCBS Complete	$3.17
Rate for Payer: Cash Price	$6.34
Rate for Payer: Cofinity Advantage	$5.55
Rate for Payer: Cofinity Commercial	$6.82
Rate for Payer: Encore Health Key Benefits Commercial	$6.34
Rate for Payer: Healthscope Commercial	$7.14
Rate for Payer: MI Amish Medical Board Commercial	$6.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.95
Rate for Payer: PHP Commercial	$6.74
Rate for Payer: Priority Health SBD	$5.00
Rate for Payer: UHC All Payor (Choice/PPO)	$5.15
Rate for Payer: UHC Core	$4.13
Rate for Payer: UHC Exchange	$3.12

OXYCODONE 5 MG TABLET

Facility

$733.25

Service Code	NDC 42858000110
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$461.95
Max. Negotiated Rate	$659.92
Rate for Payer: Aetna Commercial	$623.26
Rate for Payer: Aetna New Business (MI Preferred)	$476.61
Rate for Payer: Cash Price	$586.60
Rate for Payer: Cofinity Advantage	$513.27
Rate for Payer: Cofinity Commercial	$630.60
Rate for Payer: Encore Health Key Benefits Commercial	$586.60
Rate for Payer: Healthscope Commercial	$659.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$623.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$549.94
Rate for Payer: PHP Commercial	$623.26
Rate for Payer: Priority Health SBD	$461.95

OXYCODONE 5 MG TABLET

Facility

$610.75

Service Code	NDC 68084035411
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$240.02
Max. Negotiated Rate	$549.67
Rate for Payer: Aetna Commercial	$519.14
Rate for Payer: Aetna Medicare	$305.38
Rate for Payer: Aetna New Business (MI Preferred)	$396.99
Rate for Payer: BCBS Complete	$244.30
Rate for Payer: Cash Price	$488.60
Rate for Payer: Cofinity Advantage	$427.52
Rate for Payer: Cofinity Commercial	$525.25
Rate for Payer: Encore Health Key Benefits Commercial	$488.60
Rate for Payer: Healthscope Commercial	$549.67
Rate for Payer: MI Amish Medical Board Commercial	$488.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$519.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$458.06
Rate for Payer: PHP Commercial	$519.14
Rate for Payer: Priority Health SBD	$384.77
Rate for Payer: UHC All Payor (Choice/PPO)	$396.99
Rate for Payer: UHC Core	$318.20
Rate for Payer: UHC Exchange	$240.02

OXYCODONE 5 MG TABLET

Facility

$7.93

Service Code	NDC 00406055223
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$7.14
Rate for Payer: Aetna Commercial	$6.74
Rate for Payer: Aetna Medicare	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$5.15
Rate for Payer: BCBS Complete	$3.17
Rate for Payer: Cash Price	$6.34
Rate for Payer: Cofinity Advantage	$5.55
Rate for Payer: Cofinity Commercial	$6.82
Rate for Payer: Encore Health Key Benefits Commercial	$6.34
Rate for Payer: Healthscope Commercial	$7.14
Rate for Payer: MI Amish Medical Board Commercial	$6.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.95
Rate for Payer: PHP Commercial	$6.74
Rate for Payer: Priority Health SBD	$5.00
Rate for Payer: UHC All Payor (Choice/PPO)	$5.15
Rate for Payer: UHC Core	$4.13
Rate for Payer: UHC Exchange	$3.12

OXYCODONE 5 MG TABLET

Facility

$227.50

Service Code	NDC 10702001801
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$89.41
Max. Negotiated Rate	$204.75
Rate for Payer: Aetna Commercial	$193.38
Rate for Payer: Aetna Medicare	$113.75
Rate for Payer: Aetna New Business (MI Preferred)	$147.88
Rate for Payer: BCBS Complete	$91.00
Rate for Payer: Cash Price	$182.00
Rate for Payer: Cofinity Advantage	$159.25
Rate for Payer: Cofinity Commercial	$195.65
Rate for Payer: Encore Health Key Benefits Commercial	$182.00
Rate for Payer: Healthscope Commercial	$204.75
Rate for Payer: MI Amish Medical Board Commercial	$182.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$170.62
Rate for Payer: PHP Commercial	$193.38
Rate for Payer: Priority Health SBD	$143.32
Rate for Payer: UHC All Payor (Choice/PPO)	$147.88
Rate for Payer: UHC Core	$118.53
Rate for Payer: UHC Exchange	$89.41

Know your out-of-pocket cost for care.

All Charges