Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OXYCODONE 5 MG TABLET

Facility

$595.00

Service Code	NDC 00406055262
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$238.00
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$505.75
Rate for Payer: Aetna Medicare	$297.50
Rate for Payer: Aetna New Business (MI Preferred)	$386.75
Rate for Payer: BCBS Complete	$238.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cofinity Commercial	$416.50
Rate for Payer: Cofinity Commercial	$511.70
Rate for Payer: Cofinity Medicare Advantage	$416.50
Rate for Payer: Encore Health Key Benefits Commercial	$476.00
Rate for Payer: Healthscope Commercial	$535.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$505.75
Rate for Payer: PHP Commercial	$505.75
Rate for Payer: Priority Health Cigna Priority Health	$386.75
Rate for Payer: Priority Health SBD	$374.85

OXYCODONE 5 MG TABLET

Facility

$654.50

Service Code	NDC 68084035411
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$589.05
Rate for Payer: Aetna Commercial	$556.33
Rate for Payer: Aetna Medicare	$327.25
Rate for Payer: Aetna New Business (MI Preferred)	$425.43
Rate for Payer: BCBS Complete	$261.80
Rate for Payer: Cash Price	$523.60
Rate for Payer: Cofinity Commercial	$458.15
Rate for Payer: Cofinity Commercial	$562.87
Rate for Payer: Cofinity Medicare Advantage	$458.15
Rate for Payer: Encore Health Key Benefits Commercial	$523.60
Rate for Payer: Healthscope Commercial	$589.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$556.33
Rate for Payer: PHP Commercial	$556.33
Rate for Payer: Priority Health Cigna Priority Health	$425.43
Rate for Payer: Priority Health SBD	$412.33

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 Commercial	$166.60
Rate for Payer: Cofinity Commercial	$204.68
Rate for Payer: Cofinity Medicare Advantage	$166.60
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: PHP Commercial	$202.30
Rate for Payer: Priority Health Cigna Priority Health	$154.70
Rate for Payer: Priority Health SBD	$149.94

OXYCODONE 5 MG TABLET

Facility

$654.50

Service Code	NDC 68084035401
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$412.33
Max. Negotiated Rate	$589.05
Rate for Payer: Aetna Commercial	$556.33
Rate for Payer: Aetna New Business (MI Preferred)	$425.43
Rate for Payer: Cash Price	$523.60
Rate for Payer: Cofinity Commercial	$458.15
Rate for Payer: Cofinity Commercial	$562.87
Rate for Payer: Cofinity Medicare Advantage	$458.15
Rate for Payer: Encore Health Key Benefits Commercial	$523.60
Rate for Payer: Healthscope Commercial	$589.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$556.33
Rate for Payer: PHP Commercial	$556.33
Rate for Payer: Priority Health Cigna Priority Health	$425.43
Rate for Payer: Priority Health SBD	$412.33

OXYCODONE 5 MG TABLET

Facility

$736.75

Service Code	NDC 42858000110
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$294.70
Max. Negotiated Rate	$663.08
Rate for Payer: Aetna Commercial	$626.24
Rate for Payer: Aetna Medicare	$368.38
Rate for Payer: Aetna New Business (MI Preferred)	$478.89
Rate for Payer: BCBS Complete	$294.70
Rate for Payer: Cash Price	$589.40
Rate for Payer: Cofinity Commercial	$515.73
Rate for Payer: Cofinity Commercial	$633.61
Rate for Payer: Cofinity Medicare Advantage	$515.73
Rate for Payer: Encore Health Key Benefits Commercial	$589.40
Rate for Payer: Healthscope Commercial	$663.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.24
Rate for Payer: PHP Commercial	$626.24
Rate for Payer: Priority Health Cigna Priority Health	$478.89
Rate for Payer: Priority Health SBD	$464.15

OXYCODONE 5 MG TABLET

Facility

$201.25

Service Code	NDC 65162004710
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$80.50
Max. Negotiated Rate	$181.12
Rate for Payer: Aetna Commercial	$171.06
Rate for Payer: Aetna Medicare	$100.62
Rate for Payer: Aetna New Business (MI Preferred)	$130.81
Rate for Payer: BCBS Complete	$80.50
Rate for Payer: Cash Price	$161.00
Rate for Payer: Cofinity Commercial	$140.88
Rate for Payer: Cofinity Commercial	$173.07
Rate for Payer: Cofinity Medicare Advantage	$140.88
Rate for Payer: Encore Health Key Benefits Commercial	$161.00
Rate for Payer: Healthscope Commercial	$181.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.06
Rate for Payer: PHP Commercial	$171.06
Rate for Payer: Priority Health Cigna Priority Health	$130.81
Rate for Payer: Priority Health SBD	$126.79

OXYCODONE 5 MG TABLET

Facility

$201.25

Service Code	NDC 65162004710
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$126.79
Max. Negotiated Rate	$181.12
Rate for Payer: Aetna Commercial	$171.06
Rate for Payer: Aetna New Business (MI Preferred)	$130.81
Rate for Payer: Cash Price	$161.00
Rate for Payer: Cofinity Commercial	$140.88
Rate for Payer: Cofinity Commercial	$173.07
Rate for Payer: Cofinity Medicare Advantage	$140.88
Rate for Payer: Encore Health Key Benefits Commercial	$161.00
Rate for Payer: Healthscope Commercial	$181.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.06
Rate for Payer: PHP Commercial	$171.06
Rate for Payer: Priority Health Cigna Priority Health	$130.81
Rate for Payer: Priority Health SBD	$126.79

OXYCODONE 5 MG TABLET

Facility

$238.00

Service Code	NDC 57664022388
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$95.20
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 Commercial	$166.60
Rate for Payer: Cofinity Commercial	$204.68
Rate for Payer: Cofinity Medicare Advantage	$166.60
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: PHP Commercial	$202.30
Rate for Payer: Priority Health Cigna Priority Health	$154.70
Rate for Payer: Priority Health SBD	$149.94

OXYCODONE 5 MG TABLET

Facility

$5.95

Service Code	NDC 00406055223
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$5.06
Rate for Payer: Aetna Medicare	$2.98
Rate for Payer: Aetna New Business (MI Preferred)	$3.87
Rate for Payer: BCBS Complete	$2.38
Rate for Payer: Cash Price	$4.76
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Cofinity Commercial	$5.12
Rate for Payer: Cofinity Medicare Advantage	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$4.76
Rate for Payer: Healthscope Commercial	$5.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.06
Rate for Payer: PHP Commercial	$5.06
Rate for Payer: Priority Health Cigna Priority Health	$3.87
Rate for Payer: Priority Health SBD	$3.75

OXYCODONE 5 MG TABLET

Facility

$654.50

Service Code	NDC 68084035401
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$261.80
Max. Negotiated Rate	$589.05
Rate for Payer: Aetna Commercial	$556.33
Rate for Payer: Aetna Medicare	$327.25
Rate for Payer: Aetna New Business (MI Preferred)	$425.43
Rate for Payer: BCBS Complete	$261.80
Rate for Payer: Cash Price	$523.60
Rate for Payer: Cofinity Commercial	$458.15
Rate for Payer: Cofinity Commercial	$562.87
Rate for Payer: Cofinity Medicare Advantage	$458.15
Rate for Payer: Encore Health Key Benefits Commercial	$523.60
Rate for Payer: Healthscope Commercial	$589.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$556.33
Rate for Payer: PHP Commercial	$556.33
Rate for Payer: Priority Health Cigna Priority Health	$425.43
Rate for Payer: Priority Health SBD	$412.33

OXYCODONE 5 MG TABLET

Facility

$654.50

Service Code	NDC 68084035411
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$412.33
Max. Negotiated Rate	$589.05
Rate for Payer: Aetna Commercial	$556.33
Rate for Payer: Aetna New Business (MI Preferred)	$425.43
Rate for Payer: Cash Price	$523.60
Rate for Payer: Cofinity Commercial	$458.15
Rate for Payer: Cofinity Commercial	$562.87
Rate for Payer: Cofinity Medicare Advantage	$458.15
Rate for Payer: Encore Health Key Benefits Commercial	$523.60
Rate for Payer: Healthscope Commercial	$589.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$556.33
Rate for Payer: PHP Commercial	$556.33
Rate for Payer: Priority Health Cigna Priority Health	$425.43
Rate for Payer: Priority Health SBD	$412.33

OXYCODONE 5 MG TABLET

Facility

$227.50

Service Code	NDC 10702001801
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$91.00
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 Commercial	$159.25
Rate for Payer: Cofinity Commercial	$195.65
Rate for Payer: Cofinity Medicare Advantage	$159.25
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: PHP Commercial	$193.38
Rate for Payer: Priority Health Cigna Priority Health	$147.88
Rate for Payer: Priority Health SBD	$143.32

OXYCODONE 5 MG TABLET

Facility

$204.75

Service Code	NDC 42858000101
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$128.99
Max. Negotiated Rate	$184.28
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna New Business (MI Preferred)	$133.09
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cofinity Commercial	$143.32
Rate for Payer: Cofinity Commercial	$176.09
Rate for Payer: Cofinity Medicare Advantage	$143.32
Rate for Payer: Encore Health Key Benefits Commercial	$163.80
Rate for Payer: Healthscope Commercial	$184.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.04
Rate for Payer: PHP Commercial	$174.04
Rate for Payer: Priority Health Cigna Priority Health	$133.09
Rate for Payer: Priority Health SBD	$128.99

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$12.19

Service Code	NDC 00406052323
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$10.97
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna New Business (MI Preferred)	$7.92
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cofinity Commercial	$10.48
Rate for Payer: Cofinity Commercial	$8.53
Rate for Payer: Cofinity Medicare Advantage	$8.53
Rate for Payer: Encore Health Key Benefits Commercial	$9.75
Rate for Payer: Healthscope Commercial	$10.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.36
Rate for Payer: PHP Commercial	$10.36
Rate for Payer: Priority Health Cigna Priority Health	$7.92
Rate for Payer: Priority Health SBD	$7.68

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$1,218.70

Service Code	NDC 00406052362
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$767.78
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$1,035.89
Rate for Payer: Aetna New Business (MI Preferred)	$792.15
Rate for Payer: Cash Price	$974.96
Rate for Payer: Cofinity Commercial	$1,048.08
Rate for Payer: Cofinity Commercial	$853.09
Rate for Payer: Cofinity Medicare Advantage	$853.09
Rate for Payer: Encore Health Key Benefits Commercial	$974.96
Rate for Payer: Healthscope Commercial	$1,096.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,035.89
Rate for Payer: PHP Commercial	$1,035.89
Rate for Payer: Priority Health Cigna Priority Health	$792.15
Rate for Payer: Priority Health SBD	$767.78

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$12.19

Service Code	NDC 00406052323
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$10.97
Rate for Payer: Aetna Commercial	$10.36
Rate for Payer: Aetna Medicare	$6.09
Rate for Payer: Aetna New Business (MI Preferred)	$7.92
Rate for Payer: BCBS Complete	$4.88
Rate for Payer: Cash Price	$9.75
Rate for Payer: Cofinity Commercial	$10.48
Rate for Payer: Cofinity Commercial	$8.53
Rate for Payer: Cofinity Medicare Advantage	$8.53
Rate for Payer: Encore Health Key Benefits Commercial	$9.75
Rate for Payer: Healthscope Commercial	$10.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.36
Rate for Payer: PHP Commercial	$10.36
Rate for Payer: Priority Health Cigna Priority Health	$7.92
Rate for Payer: Priority Health SBD	$7.68

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$9.64

Service Code	NDC 68084071011
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$8.68
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: Aetna Medicare	$4.82
Rate for Payer: Aetna New Business (MI Preferred)	$6.27
Rate for Payer: BCBS Complete	$3.86
Rate for Payer: Cash Price	$7.71
Rate for Payer: Cofinity Commercial	$6.75
Rate for Payer: Cofinity Commercial	$8.29
Rate for Payer: Cofinity Medicare Advantage	$6.75
Rate for Payer: Encore Health Key Benefits Commercial	$7.71
Rate for Payer: Healthscope Commercial	$8.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.19
Rate for Payer: PHP Commercial	$8.19
Rate for Payer: Priority Health Cigna Priority Health	$6.27
Rate for Payer: Priority Health SBD	$6.07

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$9.64

Service Code	NDC 68084071011
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$6.07
Max. Negotiated Rate	$8.68
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: Aetna New Business (MI Preferred)	$6.27
Rate for Payer: Cash Price	$7.71
Rate for Payer: Cofinity Commercial	$6.75
Rate for Payer: Cofinity Commercial	$8.29
Rate for Payer: Cofinity Medicare Advantage	$6.75
Rate for Payer: Encore Health Key Benefits Commercial	$7.71
Rate for Payer: Healthscope Commercial	$8.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.19
Rate for Payer: PHP Commercial	$8.19
Rate for Payer: Priority Health Cigna Priority Health	$6.27
Rate for Payer: Priority Health SBD	$6.07

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$963.20

Service Code	NDC 68084071001
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$385.28
Max. Negotiated Rate	$866.88
Rate for Payer: Aetna Commercial	$818.72
Rate for Payer: Aetna Medicare	$481.60
Rate for Payer: Aetna New Business (MI Preferred)	$626.08
Rate for Payer: BCBS Complete	$385.28
Rate for Payer: Cash Price	$770.56
Rate for Payer: Cofinity Commercial	$674.24
Rate for Payer: Cofinity Commercial	$828.35
Rate for Payer: Cofinity Medicare Advantage	$674.24
Rate for Payer: Encore Health Key Benefits Commercial	$770.56
Rate for Payer: Healthscope Commercial	$866.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$818.72
Rate for Payer: PHP Commercial	$818.72
Rate for Payer: Priority Health Cigna Priority Health	$626.08
Rate for Payer: Priority Health SBD	$606.82

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$963.20

Service Code	NDC 68084071001
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$606.82
Max. Negotiated Rate	$866.88
Rate for Payer: Aetna Commercial	$818.72
Rate for Payer: Aetna New Business (MI Preferred)	$626.08
Rate for Payer: Cash Price	$770.56
Rate for Payer: Cofinity Commercial	$674.24
Rate for Payer: Cofinity Commercial	$828.35
Rate for Payer: Cofinity Medicare Advantage	$674.24
Rate for Payer: Encore Health Key Benefits Commercial	$770.56
Rate for Payer: Healthscope Commercial	$866.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$818.72
Rate for Payer: PHP Commercial	$818.72
Rate for Payer: Priority Health Cigna Priority Health	$626.08
Rate for Payer: Priority Health SBD	$606.82

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$760.90

Service Code	NDC 00904709561
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$304.36
Max. Negotiated Rate	$684.81
Rate for Payer: Aetna Commercial	$646.76
Rate for Payer: Aetna Medicare	$380.45
Rate for Payer: Aetna New Business (MI Preferred)	$494.58
Rate for Payer: BCBS Complete	$304.36
Rate for Payer: Cash Price	$608.72
Rate for Payer: Cofinity Commercial	$532.63
Rate for Payer: Cofinity Commercial	$654.37
Rate for Payer: Cofinity Medicare Advantage	$532.63
Rate for Payer: Encore Health Key Benefits Commercial	$608.72
Rate for Payer: Healthscope Commercial	$684.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$646.76
Rate for Payer: PHP Commercial	$646.76
Rate for Payer: Priority Health Cigna Priority Health	$494.58
Rate for Payer: Priority Health SBD	$479.37

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$760.90

Service Code	NDC 00904709561
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$479.37
Max. Negotiated Rate	$684.81
Rate for Payer: Aetna Commercial	$646.76
Rate for Payer: Aetna New Business (MI Preferred)	$494.58
Rate for Payer: Cash Price	$608.72
Rate for Payer: Cofinity Commercial	$532.63
Rate for Payer: Cofinity Commercial	$654.37
Rate for Payer: Cofinity Medicare Advantage	$532.63
Rate for Payer: Encore Health Key Benefits Commercial	$608.72
Rate for Payer: Healthscope Commercial	$684.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$646.76
Rate for Payer: PHP Commercial	$646.76
Rate for Payer: Priority Health Cigna Priority Health	$494.58
Rate for Payer: Priority Health SBD	$479.37

OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET

Facility

$1,218.70

Service Code	NDC 00406052362
Hospital Charge Code	31864
Hospital Revenue Code	637
Min. Negotiated Rate	$487.48
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Commercial	$1,035.89
Rate for Payer: Aetna Medicare	$609.35
Rate for Payer: Aetna New Business (MI Preferred)	$792.15
Rate for Payer: BCBS Complete	$487.48
Rate for Payer: Cash Price	$974.96
Rate for Payer: Cofinity Commercial	$1,048.08
Rate for Payer: Cofinity Commercial	$853.09
Rate for Payer: Cofinity Medicare Advantage	$853.09
Rate for Payer: Encore Health Key Benefits Commercial	$974.96
Rate for Payer: Healthscope Commercial	$1,096.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,035.89
Rate for Payer: PHP Commercial	$1,035.89
Rate for Payer: Priority Health Cigna Priority Health	$792.15
Rate for Payer: Priority Health SBD	$767.78

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$6.53

Service Code	NDC 00406051223
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.88
Rate for Payer: Aetna Commercial	$5.55
Rate for Payer: Aetna New Business (MI Preferred)	$4.24
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cofinity Commercial	$4.57
Rate for Payer: Cofinity Commercial	$5.62
Rate for Payer: Cofinity Medicare Advantage	$4.57
Rate for Payer: Encore Health Key Benefits Commercial	$5.22
Rate for Payer: Healthscope Commercial	$5.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.55
Rate for Payer: PHP Commercial	$5.55
Rate for Payer: Priority Health Cigna Priority Health	$4.24
Rate for Payer: Priority Health SBD	$4.11

OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET

Facility

$65.28

Service Code	NDC 00406051262
Hospital Charge Code	5940
Hospital Revenue Code	637
Min. Negotiated Rate	$41.13
Max. Negotiated Rate	$58.75
Rate for Payer: Aetna Commercial	$55.49
Rate for Payer: Aetna New Business (MI Preferred)	$42.43
Rate for Payer: Cash Price	$52.22
Rate for Payer: Cofinity Commercial	$45.70
Rate for Payer: Cofinity Commercial	$56.14
Rate for Payer: Cofinity Medicare Advantage	$45.70
Rate for Payer: Encore Health Key Benefits Commercial	$52.22
Rate for Payer: Healthscope Commercial	$58.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.49
Rate for Payer: PHP Commercial	$55.49
Rate for Payer: Priority Health Cigna Priority Health	$42.43
Rate for Payer: Priority Health SBD	$41.13

Know your out-of-pocket cost for care.

All Charges