Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$637.00

Service Code	NDC 68084035511
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$250.34
Max. Negotiated Rate	$573.30
Rate for Payer: Aetna Commercial	$541.45
Rate for Payer: Aetna Medicare	$318.50
Rate for Payer: Aetna New Business (MI Preferred)	$414.05
Rate for Payer: BCBS Complete	$254.80
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: MI Amish Medical Board Commercial	$509.60
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
Rate for Payer: UHC All Payor (Choice/PPO)	$414.05
Rate for Payer: UHC Core	$331.88
Rate for Payer: UHC Exchange	$250.34

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$637.00

Service Code	NDC 68084035501
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

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$8.23

Service Code	NDC 00406051223
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$3.23
Max. Negotiated Rate	$7.41
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna Medicare	$4.12
Rate for Payer: Aetna New Business (MI Preferred)	$5.35
Rate for Payer: BCBS Complete	$3.29
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: MI Amish Medical Board Commercial	$6.58
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
Rate for Payer: UHC All Payor (Choice/PPO)	$5.35
Rate for Payer: UHC Core	$4.29
Rate for Payer: UHC Exchange	$3.23

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$637.00

Service Code	NDC 68084035501
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$250.34
Max. Negotiated Rate	$573.30
Rate for Payer: Aetna Commercial	$541.45
Rate for Payer: Aetna Medicare	$318.50
Rate for Payer: Aetna New Business (MI Preferred)	$414.05
Rate for Payer: BCBS Complete	$254.80
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: MI Amish Medical Board Commercial	$509.60
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
Rate for Payer: UHC All Payor (Choice/PPO)	$414.05
Rate for Payer: UHC Core	$331.88
Rate for Payer: UHC Exchange	$250.34

OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET

Facility

$246.75

Service Code	NDC 13107004501
Hospital Charge Code	31863
Hospital Revenue Code	637
Min. Negotiated Rate	$96.97
Max. Negotiated Rate	$222.07
Rate for Payer: Aetna Commercial	$209.74
Rate for Payer: Aetna Medicare	$123.38
Rate for Payer: Aetna New Business (MI Preferred)	$160.39
Rate for Payer: BCBS Complete	$98.70
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Advantage	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$222.07
Rate for Payer: MI Amish Medical Board Commercial	$197.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.06
Rate for Payer: PHP Commercial	$209.74
Rate for Payer: Priority Health SBD	$155.45
Rate for Payer: UHC All Payor (Choice/PPO)	$160.39
Rate for Payer: UHC Core	$128.56
Rate for Payer: UHC Exchange	$96.97

OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET

Facility

$246.75

Service Code	NDC 13107004501
Hospital Charge Code	31863
Hospital Revenue Code	637
Min. Negotiated Rate	$155.45
Max. Negotiated Rate	$222.07
Rate for Payer: Aetna Commercial	$209.74
Rate for Payer: Aetna New Business (MI Preferred)	$160.39
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Advantage	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$222.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.06
Rate for Payer: PHP Commercial	$209.74
Rate for Payer: Priority Health SBD	$155.45

OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET

Facility

$1,305.50

Service Code	NDC 00406052262
Hospital Charge Code	31863
Hospital Revenue Code	637
Min. Negotiated Rate	$822.47
Max. Negotiated Rate	$1,174.95
Rate for Payer: Aetna Commercial	$1,109.67
Rate for Payer: Aetna New Business (MI Preferred)	$848.58
Rate for Payer: Cash Price	$1,044.40
Rate for Payer: Cofinity Advantage	$913.85
Rate for Payer: Cofinity Commercial	$1,122.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,044.40
Rate for Payer: Healthscope Commercial	$1,174.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,109.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$979.12
Rate for Payer: PHP Commercial	$1,109.67
Rate for Payer: Priority Health SBD	$822.47

OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET

Facility

$13.06

Service Code	NDC 00406052223
Hospital Charge Code	31863
Hospital Revenue Code	637
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$11.75
Rate for Payer: Aetna Commercial	$11.10
Rate for Payer: Aetna Medicare	$6.53
Rate for Payer: Aetna New Business (MI Preferred)	$8.49
Rate for Payer: BCBS Complete	$5.22
Rate for Payer: Cash Price	$10.45
Rate for Payer: Cofinity Advantage	$9.14
Rate for Payer: Cofinity Commercial	$11.23
Rate for Payer: Encore Health Key Benefits Commercial	$10.45
Rate for Payer: Healthscope Commercial	$11.75
Rate for Payer: MI Amish Medical Board Commercial	$10.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.79
Rate for Payer: PHP Commercial	$11.10
Rate for Payer: Priority Health SBD	$8.23
Rate for Payer: UHC All Payor (Choice/PPO)	$8.49
Rate for Payer: UHC Core	$6.80
Rate for Payer: UHC Exchange	$5.13

OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET

Facility

$1,305.50

Service Code	NDC 00406052262
Hospital Charge Code	31863
Hospital Revenue Code	637
Min. Negotiated Rate	$513.06
Max. Negotiated Rate	$1,174.95
Rate for Payer: Aetna Commercial	$1,109.67
Rate for Payer: Aetna Medicare	$652.75
Rate for Payer: Aetna New Business (MI Preferred)	$848.58
Rate for Payer: BCBS Complete	$522.20
Rate for Payer: Cash Price	$1,044.40
Rate for Payer: Cofinity Advantage	$913.85
Rate for Payer: Cofinity Commercial	$1,122.73
Rate for Payer: Encore Health Key Benefits Commercial	$1,044.40
Rate for Payer: Healthscope Commercial	$1,174.95
Rate for Payer: MI Amish Medical Board Commercial	$1,044.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,109.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$979.12
Rate for Payer: PHP Commercial	$1,109.67
Rate for Payer: Priority Health SBD	$822.47
Rate for Payer: UHC All Payor (Choice/PPO)	$848.58
Rate for Payer: UHC Core	$680.17
Rate for Payer: UHC Exchange	$513.06

OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET

Facility

$13.06

Service Code	NDC 00406052223
Hospital Charge Code	31863
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 Advantage	$9.14
Rate for Payer: Cofinity Commercial	$11.23
Rate for Payer: Encore Health Key Benefits Commercial	$10.45
Rate for Payer: Healthscope Commercial	$11.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.79
Rate for Payer: PHP Commercial	$11.10
Rate for Payer: Priority Health SBD	$8.23

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$346.01

Service Code	NDC 59011041020
Hospital Charge Code	173651
Hospital Revenue Code	637
Min. Negotiated Rate	$135.98
Max. Negotiated Rate	$311.41
Rate for Payer: Aetna Commercial	$294.11
Rate for Payer: Aetna Medicare	$173.00
Rate for Payer: Aetna New Business (MI Preferred)	$224.91
Rate for Payer: BCBS Complete	$138.40
Rate for Payer: Cash Price	$276.81
Rate for Payer: Cofinity Advantage	$242.21
Rate for Payer: Cofinity Commercial	$297.57
Rate for Payer: Encore Health Key Benefits Commercial	$276.81
Rate for Payer: Healthscope Commercial	$311.41
Rate for Payer: MI Amish Medical Board Commercial	$276.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$294.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$259.51
Rate for Payer: PHP Commercial	$294.11
Rate for Payer: Priority Health SBD	$217.99
Rate for Payer: UHC All Payor (Choice/PPO)	$224.91
Rate for Payer: UHC Core	$180.27
Rate for Payer: UHC Exchange	$135.98

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$877.11

Service Code	NDC 00093573101
Hospital Charge Code	173651
Hospital Revenue Code	637
Min. Negotiated Rate	$344.70
Max. Negotiated Rate	$789.40
Rate for Payer: Aetna Commercial	$745.54
Rate for Payer: Aetna Medicare	$438.56
Rate for Payer: Aetna New Business (MI Preferred)	$570.12
Rate for Payer: BCBS Complete	$350.84
Rate for Payer: Cash Price	$701.69
Rate for Payer: Cofinity Advantage	$613.98
Rate for Payer: Cofinity Commercial	$754.31
Rate for Payer: Encore Health Key Benefits Commercial	$701.69
Rate for Payer: Healthscope Commercial	$789.40
Rate for Payer: MI Amish Medical Board Commercial	$701.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$745.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$657.83
Rate for Payer: PHP Commercial	$745.54
Rate for Payer: Priority Health SBD	$552.58
Rate for Payer: UHC All Payor (Choice/PPO)	$570.12
Rate for Payer: UHC Core	$456.97
Rate for Payer: UHC Exchange	$344.70

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$877.11

Service Code	NDC 00093573101
Hospital Charge Code	173651
Hospital Revenue Code	637
Min. Negotiated Rate	$552.58
Max. Negotiated Rate	$789.40
Rate for Payer: Aetna Commercial	$745.54
Rate for Payer: Aetna New Business (MI Preferred)	$570.12
Rate for Payer: Cash Price	$701.69
Rate for Payer: Cofinity Advantage	$613.98
Rate for Payer: Cofinity Commercial	$754.31
Rate for Payer: Encore Health Key Benefits Commercial	$701.69
Rate for Payer: Healthscope Commercial	$789.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$745.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$657.83
Rate for Payer: PHP Commercial	$745.54
Rate for Payer: Priority Health SBD	$552.58

OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$346.01

Service Code	NDC 59011041020
Hospital Charge Code	173651
Hospital Revenue Code	637
Min. Negotiated Rate	$217.99
Max. Negotiated Rate	$311.41
Rate for Payer: Aetna Commercial	$294.11
Rate for Payer: Aetna New Business (MI Preferred)	$224.91
Rate for Payer: Cash Price	$276.81
Rate for Payer: Cofinity Advantage	$242.21
Rate for Payer: Cofinity Commercial	$297.57
Rate for Payer: Encore Health Key Benefits Commercial	$276.81
Rate for Payer: Healthscope Commercial	$311.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$294.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$259.51
Rate for Payer: PHP Commercial	$294.11
Rate for Payer: Priority Health SBD	$217.99

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$2,659.14

Service Code	NDC 59011042010
Hospital Charge Code	173653
Hospital Revenue Code	637
Min. Negotiated Rate	$1,675.26
Max. Negotiated Rate	$2,393.23
Rate for Payer: Aetna Commercial	$2,260.27
Rate for Payer: Aetna New Business (MI Preferred)	$1,728.44
Rate for Payer: Cash Price	$2,127.31
Rate for Payer: Cofinity Advantage	$1,861.40
Rate for Payer: Cofinity Commercial	$2,286.86
Rate for Payer: Encore Health Key Benefits Commercial	$2,127.31
Rate for Payer: Healthscope Commercial	$2,393.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,260.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,994.36
Rate for Payer: PHP Commercial	$2,260.27
Rate for Payer: Priority Health SBD	$1,675.26

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$545.43

Service Code	NDC 59011042020
Hospital Charge Code	173653
Hospital Revenue Code	637
Min. Negotiated Rate	$214.35
Max. Negotiated Rate	$490.89
Rate for Payer: Aetna Commercial	$463.62
Rate for Payer: Aetna Medicare	$272.71
Rate for Payer: Aetna New Business (MI Preferred)	$354.53
Rate for Payer: BCBS Complete	$218.17
Rate for Payer: Cash Price	$436.34
Rate for Payer: Cofinity Advantage	$381.80
Rate for Payer: Cofinity Commercial	$469.07
Rate for Payer: Encore Health Key Benefits Commercial	$436.34
Rate for Payer: Healthscope Commercial	$490.89
Rate for Payer: MI Amish Medical Board Commercial	$436.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$463.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$409.07
Rate for Payer: PHP Commercial	$463.62
Rate for Payer: Priority Health SBD	$343.62
Rate for Payer: UHC All Payor (Choice/PPO)	$354.53
Rate for Payer: UHC Core	$284.17
Rate for Payer: UHC Exchange	$214.35

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$2,659.14

Service Code	NDC 59011042010
Hospital Charge Code	173653
Hospital Revenue Code	637
Min. Negotiated Rate	$1,045.04
Max. Negotiated Rate	$2,393.23
Rate for Payer: Aetna Commercial	$2,260.27
Rate for Payer: Aetna Medicare	$1,329.57
Rate for Payer: Aetna New Business (MI Preferred)	$1,728.44
Rate for Payer: BCBS Complete	$1,063.66
Rate for Payer: Cash Price	$2,127.31
Rate for Payer: Cofinity Advantage	$1,861.40
Rate for Payer: Cofinity Commercial	$2,286.86
Rate for Payer: Encore Health Key Benefits Commercial	$2,127.31
Rate for Payer: Healthscope Commercial	$2,393.23
Rate for Payer: MI Amish Medical Board Commercial	$2,127.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,260.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,994.36
Rate for Payer: PHP Commercial	$2,260.27
Rate for Payer: Priority Health SBD	$1,675.26
Rate for Payer: UHC All Payor (Choice/PPO)	$1,728.44
Rate for Payer: UHC Core	$1,385.41
Rate for Payer: UHC Exchange	$1,045.04

OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR

Facility

$545.43

Service Code	NDC 59011042020
Hospital Charge Code	173653
Hospital Revenue Code	637
Min. Negotiated Rate	$343.62
Max. Negotiated Rate	$490.89
Rate for Payer: Aetna Commercial	$463.62
Rate for Payer: Aetna New Business (MI Preferred)	$354.53
Rate for Payer: Cash Price	$436.34
Rate for Payer: Cofinity Advantage	$381.80
Rate for Payer: Cofinity Commercial	$469.07
Rate for Payer: Encore Health Key Benefits Commercial	$436.34
Rate for Payer: Healthscope Commercial	$490.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$463.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$409.07
Rate for Payer: PHP Commercial	$463.62
Rate for Payer: Priority Health SBD	$343.62

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$27.15

Service Code	NDC 41100081123
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$24.43
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: Cash Price	$21.72
Rate for Payer: Cofinity Advantage	$19.00
Rate for Payer: Cofinity Commercial	$23.35
Rate for Payer: Encore Health Key Benefits Commercial	$21.72
Rate for Payer: Healthscope Commercial	$24.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.36
Rate for Payer: PHP Commercial	$23.08
Rate for Payer: Priority Health SBD	$17.10

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$27.15

Service Code	NDC 41100081123
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$24.43
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna Medicare	$13.57
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: BCBS Complete	$10.86
Rate for Payer: Cash Price	$21.72
Rate for Payer: Cofinity Advantage	$19.00
Rate for Payer: Cofinity Commercial	$23.35
Rate for Payer: Encore Health Key Benefits Commercial	$21.72
Rate for Payer: Healthscope Commercial	$24.43
Rate for Payer: MI Amish Medical Board Commercial	$21.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.36
Rate for Payer: PHP Commercial	$23.08
Rate for Payer: Priority Health SBD	$17.10
Rate for Payer: UHC All Payor (Choice/PPO)	$17.65
Rate for Payer: UHC Core	$14.15
Rate for Payer: UHC Exchange	$10.67

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$10.53

Service Code	NDC 00904700635
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna Commercial	$8.95
Rate for Payer: Aetna New Business (MI Preferred)	$6.84
Rate for Payer: Cash Price	$8.42
Rate for Payer: Cofinity Advantage	$7.37
Rate for Payer: Cofinity Commercial	$9.06
Rate for Payer: Encore Health Key Benefits Commercial	$8.42
Rate for Payer: Healthscope Commercial	$9.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.90
Rate for Payer: PHP Commercial	$8.95
Rate for Payer: Priority Health SBD	$6.63

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$24.84

Service Code	NDC 23900001252
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$9.76
Max. Negotiated Rate	$22.36
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna Medicare	$12.42
Rate for Payer: Aetna New Business (MI Preferred)	$16.15
Rate for Payer: BCBS Complete	$9.94
Rate for Payer: Cash Price	$19.87
Rate for Payer: Cofinity Advantage	$17.39
Rate for Payer: Cofinity Commercial	$21.36
Rate for Payer: Encore Health Key Benefits Commercial	$19.87
Rate for Payer: Healthscope Commercial	$22.36
Rate for Payer: MI Amish Medical Board Commercial	$19.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.63
Rate for Payer: PHP Commercial	$21.11
Rate for Payer: Priority Health SBD	$15.65
Rate for Payer: UHC All Payor (Choice/PPO)	$16.15
Rate for Payer: UHC Core	$12.94
Rate for Payer: UHC Exchange	$9.76

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$24.84

Service Code	NDC 23900001252
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$22.36
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.15
Rate for Payer: Cash Price	$19.87
Rate for Payer: Cofinity Advantage	$17.39
Rate for Payer: Cofinity Commercial	$21.36
Rate for Payer: Encore Health Key Benefits Commercial	$19.87
Rate for Payer: Healthscope Commercial	$22.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.63
Rate for Payer: PHP Commercial	$21.11
Rate for Payer: Priority Health SBD	$15.65

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$9.45

Service Code	NDC 00904676130
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$8.51
Rate for Payer: Aetna Commercial	$8.03
Rate for Payer: Aetna Medicare	$4.72
Rate for Payer: Aetna New Business (MI Preferred)	$6.14
Rate for Payer: BCBS Complete	$3.78
Rate for Payer: Cash Price	$7.56
Rate for Payer: Cofinity Advantage	$6.62
Rate for Payer: Cofinity Commercial	$8.13
Rate for Payer: Encore Health Key Benefits Commercial	$7.56
Rate for Payer: Healthscope Commercial	$8.51
Rate for Payer: MI Amish Medical Board Commercial	$7.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.09
Rate for Payer: PHP Commercial	$8.03
Rate for Payer: Priority Health SBD	$5.95
Rate for Payer: UHC All Payor (Choice/PPO)	$6.14
Rate for Payer: UHC Core	$4.92
Rate for Payer: UHC Exchange	$3.71

OXYMETAZOLINE 0.05 % NASAL SPRAY

Facility

$9.45

Service Code	NDC 00904676130
Hospital Charge Code	5943
Hospital Revenue Code	637
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$8.51
Rate for Payer: Aetna Commercial	$8.03
Rate for Payer: Aetna New Business (MI Preferred)	$6.14
Rate for Payer: Cash Price	$7.56
Rate for Payer: Cofinity Advantage	$6.62
Rate for Payer: Cofinity Commercial	$8.13
Rate for Payer: Encore Health Key Benefits Commercial	$7.56
Rate for Payer: Healthscope Commercial	$8.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.09
Rate for Payer: PHP Commercial	$8.03
Rate for Payer: Priority Health SBD	$5.95

Know your out-of-pocket cost for care.

All Charges