|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 0904-2821-61
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: BCBS Trust/PPO |
$251.82
|
| Rate for Payer: BCN Commercial |
$251.82
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.75
|
| Rate for Payer: UHC Core |
$272.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 0832-0038-01
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.00 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: BCBS Trust/PPO |
$249.61
|
| Rate for Payer: BCN Commercial |
$249.61
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.24
|
| Rate for Payer: UHC Core |
$269.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084-400-01
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.70 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: BCBS Trust/PPO |
$274.58
|
| Rate for Payer: BCN Commercial |
$274.58
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.66
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$245.43
|
|
|
Service Code
|
NDC 0904-6570-04
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.69 |
| Max. Negotiated Rate |
$220.89 |
| Rate for Payer: Aetna Commercial |
$208.62
|
| Rate for Payer: BCBS Trust/PPO |
$189.67
|
| Rate for Payer: BCN Commercial |
$189.67
|
| Rate for Payer: Cash Price |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$211.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.34
|
| Rate for Payer: Healthscope Commercial |
$220.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.62
|
| Rate for Payer: PHP Commercial |
$208.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.98
|
| Rate for Payer: UHC Core |
$204.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.07
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$635.25
|
|
|
Service Code
|
NDC 68084-354-01
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.44 |
| Max. Negotiated Rate |
$571.72 |
| Rate for Payer: Aetna Commercial |
$539.96
|
| Rate for Payer: BCBS Trust/PPO |
$490.92
|
| Rate for Payer: BCN Commercial |
$490.92
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cofinity Commercial |
$546.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.20
|
| Rate for Payer: Healthscope Commercial |
$571.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$539.96
|
| Rate for Payer: PHP Commercial |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.02
|
| Rate for Payer: UHC Core |
$530.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.44
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 0406-0552-23
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.49
|
| Rate for Payer: BCN Commercial |
$4.49
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.94
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
NDC 0406-0552-62
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.35 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna Commercial |
$493.85
|
| Rate for Payer: BCBS Trust/PPO |
$449.00
|
| Rate for Payer: BCN Commercial |
$449.00
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$499.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.80
|
| Rate for Payer: Healthscope Commercial |
$522.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.85
|
| Rate for Payer: PHP Commercial |
$493.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$354.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.28
|
| Rate for Payer: UHC Core |
$485.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.75
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$635.25
|
|
|
Service Code
|
NDC 68084-354-11
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.44 |
| Max. Negotiated Rate |
$571.72 |
| Rate for Payer: Aetna Commercial |
$539.96
|
| Rate for Payer: BCBS Trust/PPO |
$490.92
|
| Rate for Payer: BCN Commercial |
$490.92
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cofinity Commercial |
$546.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.20
|
| Rate for Payer: Healthscope Commercial |
$571.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$539.96
|
| Rate for Payer: PHP Commercial |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$387.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$559.02
|
| Rate for Payer: UHC Core |
$530.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.44
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 10702-018-01
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.72 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: BCBS Trust/PPO |
$114.95
|
| Rate for Payer: BCN Commercial |
$114.95
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.90
|
| Rate for Payer: UHC Core |
$124.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$432.25
|
|
|
Service Code
|
NDC 0904-6966-61
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.63 |
| Max. Negotiated Rate |
$389.02 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: BCBS Trust/PPO |
$334.04
|
| Rate for Payer: BCN Commercial |
$334.04
|
| Rate for Payer: Cash Price |
$345.80
|
| Rate for Payer: Cofinity Commercial |
$371.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.80
|
| Rate for Payer: Healthscope Commercial |
$389.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.41
|
| Rate for Payer: PHP Commercial |
$367.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.38
|
| Rate for Payer: UHC Core |
$360.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.19
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$680.75
|
|
|
Service Code
|
NDC 42858-001-10
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$415.19 |
| Max. Negotiated Rate |
$612.68 |
| Rate for Payer: Aetna Commercial |
$578.64
|
| Rate for Payer: BCBS Trust/PPO |
$526.08
|
| Rate for Payer: BCN Commercial |
$526.08
|
| Rate for Payer: Cash Price |
$544.60
|
| Rate for Payer: Cofinity Commercial |
$585.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.60
|
| Rate for Payer: Healthscope Commercial |
$612.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$578.64
|
| Rate for Payer: PHP Commercial |
$578.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$415.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.06
|
| Rate for Payer: UHC Core |
$568.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$285.25
|
|
|
Service Code
|
NDC 42806-005-01
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.97 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Aetna Commercial |
$242.46
|
| Rate for Payer: BCBS Trust/PPO |
$220.44
|
| Rate for Payer: BCN Commercial |
$220.44
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cofinity Commercial |
$245.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.20
|
| Rate for Payer: Healthscope Commercial |
$256.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.46
|
| Rate for Payer: PHP Commercial |
$242.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.02
|
| Rate for Payer: UHC Core |
$238.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.94
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$1,305.50
|
|
|
Service Code
|
NDC 0406-0523-62
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$796.22 |
| Max. Negotiated Rate |
$1,174.95 |
| Rate for Payer: Aetna Commercial |
$1,109.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.89
|
| Rate for Payer: BCN Commercial |
$1,008.89
|
| Rate for Payer: Cash Price |
$1,044.40
|
| 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: Lakeland Regional Health Systems Commercial |
$979.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.68
|
| Rate for Payer: PHP Commercial |
$1,109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$796.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,148.84
|
| Rate for Payer: UHC Core |
$1,090.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$979.12
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$13.06
|
|
|
Service Code
|
NDC 0406-0523-23
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$11.75 |
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: BCN Commercial |
$10.09
|
| Rate for Payer: Cash Price |
$10.45
|
| 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: Lakeland Regional Health Systems Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.10
|
| Rate for Payer: PHP Commercial |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.49
|
| Rate for Payer: UHC Core |
$10.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.80
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$753.20
|
|
|
Service Code
|
NDC 0904-7095-61
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$459.38 |
| Max. Negotiated Rate |
$677.88 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: BCBS Trust/PPO |
$582.07
|
| Rate for Payer: BCN Commercial |
$582.07
|
| Rate for Payer: Cash Price |
$602.56
|
| Rate for Payer: Cofinity Commercial |
$647.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.56
|
| Rate for Payer: Healthscope Commercial |
$677.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$640.22
|
| Rate for Payer: PHP Commercial |
$640.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$459.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$662.82
|
| Rate for Payer: UHC Core |
$628.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.90
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$10.27
|
|
|
Service Code
|
NDC 68084-710-11
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: BCBS Trust/PPO |
$7.94
|
| Rate for Payer: BCN Commercial |
$7.94
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.73
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.04
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$1,026.20
|
|
|
Service Code
|
NDC 68084-710-01
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.88 |
| Max. Negotiated Rate |
$923.58 |
| Rate for Payer: Aetna Commercial |
$872.27
|
| Rate for Payer: BCBS Trust/PPO |
$793.05
|
| Rate for Payer: BCN Commercial |
$793.05
|
| Rate for Payer: Cash Price |
$820.96
|
| Rate for Payer: Cofinity Commercial |
$882.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.96
|
| Rate for Payer: Healthscope Commercial |
$923.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$872.27
|
| Rate for Payer: PHP Commercial |
$872.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$718.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$892.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$625.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.06
|
| Rate for Payer: UHC Core |
$856.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.65
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
NDC 47781-196-01
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.12 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$102.78
|
| Rate for Payer: BCN Commercial |
$102.78
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$114.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.05
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$111.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.75
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 0406-0512-62
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: BCBS Trust/PPO |
$54.10
|
| Rate for Payer: BCN Commercial |
$54.10
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.60
|
| Rate for Payer: UHC Core |
$58.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
NDC 68084-355-11
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.51 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: Aetna Commercial |
$541.45
|
| Rate for Payer: BCBS Trust/PPO |
$492.27
|
| Rate for Payer: BCN Commercial |
$492.27
|
| Rate for Payer: Cash Price |
$509.60
|
| 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: Lakeland Regional Health Systems Commercial |
$477.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$541.45
|
| Rate for Payer: PHP Commercial |
$541.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$388.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.56
|
| Rate for Payer: UHC Core |
$531.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.75
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 0406-0512-23
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.41
|
| Rate for Payer: BCN Commercial |
$5.41
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.95
|
| Rate for Payer: PHP Commercial |
$5.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.16
|
| Rate for Payer: UHC Core |
$5.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.25
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$11.06
|
|
|
Service Code
|
NDC 0406-0522-23
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$9.95 |
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.85
|
| Rate for Payer: Healthscope Commercial |
$9.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.40
|
| Rate for Payer: PHP Commercial |
$9.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.73
|
| Rate for Payer: UHC Core |
$9.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.30
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
NDC 0904-6438-61
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.31 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: BCBS Trust/PPO |
$367.85
|
| Rate for Payer: BCN Commercial |
$367.85
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.60
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$290.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.88
|
| Rate for Payer: UHC Core |
$397.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,105.30
|
|
|
Service Code
|
NDC 0406-0522-62
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$674.12 |
| Max. Negotiated Rate |
$994.77 |
| Rate for Payer: Aetna Commercial |
$939.50
|
| Rate for Payer: BCBS Trust/PPO |
$854.18
|
| Rate for Payer: BCN Commercial |
$854.18
|
| Rate for Payer: Cash Price |
$884.24
|
| Rate for Payer: Cofinity Commercial |
$950.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$884.24
|
| Rate for Payer: Healthscope Commercial |
$994.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$939.50
|
| Rate for Payer: PHP Commercial |
$939.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$961.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$674.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$972.66
|
| Rate for Payer: UHC Core |
$922.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.98
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$298.74
|
|
|
Service Code
|
NDC 59011-410-20
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: BCBS Trust/PPO |
$230.87
|
| Rate for Payer: BCN Commercial |
$230.87
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.93
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.89
|
| Rate for Payer: UHC Core |
$249.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
