|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$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
|
IP
|
$792.75
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.43 |
| Max. Negotiated Rate |
$713.48 |
| Rate for Payer: Aetna Commercial |
$673.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.29
|
| 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: 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
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$792.75
|
|
|
Service Code
|
NDC 406055262
|
| 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
|
IP
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.32 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.88
|
| 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: 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
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$484.75
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.39 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| 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: 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
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$610.75
|
|
|
Service Code
|
NDC 68084035411
|
| 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
|
OP
|
$208.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$187.43 |
| Rate for Payer: Aetna Commercial |
$177.01
|
| Rate for Payer: Aetna Medicare |
$104.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.36
|
| Rate for Payer: BCBS Complete |
$83.30
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cofinity Advantage |
$145.78
|
| Rate for Payer: Cofinity Commercial |
$179.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.60
|
| Rate for Payer: Healthscope Commercial |
$187.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.19
|
| Rate for Payer: PHP Commercial |
$177.01
|
| Rate for Payer: Priority Health SBD |
$131.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.36
|
| Rate for Payer: UHC Core |
$108.50
|
| Rate for Payer: UHC Exchange |
$81.84
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$7.93
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| 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: 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
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$208.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$187.43 |
| Rate for Payer: Aetna Commercial |
$177.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.36
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cofinity Advantage |
$145.78
|
| Rate for Payer: Cofinity Commercial |
$179.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.60
|
| Rate for Payer: Healthscope Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.19
|
| Rate for Payer: PHP Commercial |
$177.01
|
| Rate for Payer: Priority Health SBD |
$131.20
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.53 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Advantage |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.50
|
| Rate for Payer: UHC Core |
$109.41
|
| Rate for Payer: UHC Exchange |
$82.53
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Advantage |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health SBD |
$132.30
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$8.57
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$7.71 |
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.57
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Advantage |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.28
|
| Rate for Payer: Priority Health SBD |
$5.40
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$856.05
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.43 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna Commercial |
$727.64
|
| Rate for Payer: Aetna Medicare |
$428.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.43
|
| Rate for Payer: BCBS Complete |
$342.42
|
| Rate for Payer: Cash Price |
$684.84
|
| Rate for Payer: Cofinity Advantage |
$599.24
|
| Rate for Payer: Cofinity Commercial |
$736.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.84
|
| Rate for Payer: Healthscope Commercial |
$770.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$684.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.04
|
| Rate for Payer: PHP Commercial |
$727.64
|
| Rate for Payer: Priority Health SBD |
$539.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.43
|
| Rate for Payer: UHC Core |
$446.00
|
| Rate for Payer: UHC Exchange |
$336.43
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$856.05
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$539.31 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna Commercial |
$727.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.43
|
| Rate for Payer: Cash Price |
$684.84
|
| Rate for Payer: Cofinity Advantage |
$599.24
|
| Rate for Payer: Cofinity Commercial |
$736.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.84
|
| Rate for Payer: Healthscope Commercial |
$770.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.04
|
| Rate for Payer: PHP Commercial |
$727.64
|
| Rate for Payer: Priority Health SBD |
$539.31
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$8.57
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$7.71 |
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.57
|
| Rate for Payer: BCBS Complete |
$3.43
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Advantage |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.28
|
| Rate for Payer: Priority Health SBD |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.57
|
| Rate for Payer: UHC Core |
$4.46
|
| Rate for Payer: UHC Exchange |
$3.37
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Advantage |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: Priority Health SBD |
$6.75
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$1,071.70
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.18 |
| Max. Negotiated Rate |
$964.53 |
| Rate for Payer: Aetna Commercial |
$910.95
|
| Rate for Payer: Aetna Medicare |
$535.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.61
|
| Rate for Payer: BCBS Complete |
$428.68
|
| Rate for Payer: Cash Price |
$857.36
|
| Rate for Payer: Cofinity Advantage |
$750.19
|
| Rate for Payer: Cofinity Commercial |
$921.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.36
|
| Rate for Payer: Healthscope Commercial |
$964.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$857.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.77
|
| Rate for Payer: PHP Commercial |
$910.95
|
| Rate for Payer: Priority Health SBD |
$675.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.61
|
| Rate for Payer: UHC Core |
$558.36
|
| Rate for Payer: UHC Exchange |
$421.18
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$1,071.70
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$675.17 |
| Max. Negotiated Rate |
$964.53 |
| Rate for Payer: Aetna Commercial |
$910.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.61
|
| Rate for Payer: Cash Price |
$857.36
|
| Rate for Payer: Cofinity Advantage |
$750.19
|
| Rate for Payer: Cofinity Commercial |
$921.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.36
|
| Rate for Payer: Healthscope Commercial |
$964.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.77
|
| Rate for Payer: PHP Commercial |
$910.95
|
| Rate for Payer: Priority Health SBD |
$675.17
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$974.40
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.94 |
| Max. Negotiated Rate |
$876.96 |
| Rate for Payer: Aetna Commercial |
$828.24
|
| Rate for Payer: Aetna Medicare |
$487.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.36
|
| Rate for Payer: BCBS Complete |
$389.76
|
| Rate for Payer: Cash Price |
$779.52
|
| Rate for Payer: Cofinity Advantage |
$682.08
|
| Rate for Payer: Cofinity Commercial |
$837.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.52
|
| Rate for Payer: Healthscope Commercial |
$876.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$779.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$730.80
|
| Rate for Payer: PHP Commercial |
$828.24
|
| Rate for Payer: Priority Health SBD |
$613.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.36
|
| Rate for Payer: UHC Core |
$507.66
|
| Rate for Payer: UHC Exchange |
$382.94
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$5.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.97
|
| Rate for Payer: BCBS Complete |
$4.29
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Advantage |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.97
|
| Rate for Payer: UHC Core |
$5.59
|
| Rate for Payer: UHC Exchange |
$4.21
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$974.40
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$613.87 |
| Max. Negotiated Rate |
$876.96 |
| Rate for Payer: Aetna Commercial |
$828.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.36
|
| Rate for Payer: Cash Price |
$779.52
|
| Rate for Payer: Cofinity Advantage |
$682.08
|
| Rate for Payer: Cofinity Commercial |
$837.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.52
|
| Rate for Payer: Healthscope Commercial |
$876.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$730.80
|
| Rate for Payer: PHP Commercial |
$828.24
|
| Rate for Payer: Priority Health SBD |
$613.87
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$8.23
|
|
|
Service Code
|
NDC 00406051223
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$7.41 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.35
|
| Rate for Payer: Cash Price |
$6.58
|
| Rate for Payer: Cofinity Advantage |
$5.76
|
| Rate for Payer: Cofinity Commercial |
$7.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.17
|
| Rate for Payer: PHP Commercial |
$7.00
|
| Rate for Payer: Priority Health SBD |
$5.18
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
NDC 68084035511
|
| 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 Advantage |
$445.90
|
| Rate for Payer: Cofinity Commercial |
$547.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$509.60
|
| Rate for Payer: Healthscope Commercial |
$573.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.75
|
| Rate for Payer: PHP Commercial |
$541.45
|
| Rate for Payer: Priority Health SBD |
$401.31
|
|
