|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.47
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Nomi Health Commercial |
$2.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.04 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: BCBS Trust/PPO |
$351.30
|
| Rate for Payer: BCN Commercial |
$351.30
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$370.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.31
|
| Rate for Payer: UHC Core |
$355.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.93
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: BCBS MAPPO |
$0.75
|
| Rate for Payer: BCBS Trust/PPO |
$2.46
|
| Rate for Payer: BCN Commercial |
$2.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.75
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.75
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Mclaren Medicaid |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.78
|
| Rate for Payer: Meridian Medicaid |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Nomi Health Commercial |
$2.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.24
|
| Rate for Payer: PACE Senior Care Partners |
$0.71
|
| Rate for Payer: PACE SWMI |
$0.75
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$0.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.50
|
| Rate for Payer: UHC Exchange |
$0.75
|
| Rate for Payer: UHC Medicaid |
$0.53
|
| Rate for Payer: UHC Medicare Advantage |
$0.75
|
| Rate for Payer: UHCCP Medicaid |
$0.53
|
| Rate for Payer: VA VA |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 51991029301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$382.81 |
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Medicare |
$110.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$132.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$132.92
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$106.34
|
| Rate for Payer: BCBS Trust/PPO |
$349.68
|
| Rate for Payer: BCN Commercial |
$349.68
|
| Rate for Payer: BCN Medicare Advantage |
$106.34
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.34
|
| Rate for Payer: Healthscope Commercial |
$382.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.01
|
| Rate for Payer: Mclaren Medicaid |
$74.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.65
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.01
|
| Rate for Payer: PACE Senior Care Partners |
$101.02
|
| Rate for Payer: PACE SWMI |
$106.34
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: PHP Medicare Advantage |
$106.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$370.05
|
| Rate for Payer: Priority Health Medicare |
$107.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$296.04
|
| Rate for Payer: Railroad Medicare Medicare |
$106.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.31
|
| Rate for Payer: UHC Core |
$355.17
|
| Rate for Payer: UHC Exchange |
$106.34
|
| Rate for Payer: UHC Medicaid |
$74.99
|
| Rate for Payer: UHC Medicare Advantage |
$106.34
|
| Rate for Payer: UHCCP Medicaid |
$74.99
|
| Rate for Payer: VA VA |
$106.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.01
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.80 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: BCBS Trust/PPO |
$246.58
|
| Rate for Payer: BCN Commercial |
$246.58
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$249.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.92
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$367.20
|
|
|
Service Code
|
NDC 00904726361
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.57 |
| Max. Negotiated Rate |
$330.48 |
| Rate for Payer: Aetna Commercial |
$312.12
|
| Rate for Payer: BCBS Trust/PPO |
$303.27
|
| Rate for Payer: BCN Commercial |
$303.27
|
| Rate for Payer: Cash Price |
$293.76
|
| Rate for Payer: Cofinity Commercial |
$315.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.76
|
| Rate for Payer: Healthscope Commercial |
$330.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.12
|
| Rate for Payer: Nomi Health Commercial |
$301.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.40
|
| Rate for Payer: PHP Commercial |
$312.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$319.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.14
|
| Rate for Payer: UHC Core |
$306.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.40
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.64 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: Aetna Medicare |
$77.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.30
|
| Rate for Payer: BCBS Complete |
$55.26
|
| Rate for Payer: BCBS MAPPO |
$74.64
|
| Rate for Payer: BCBS Trust/PPO |
$245.45
|
| Rate for Payer: BCN Commercial |
$245.45
|
| Rate for Payer: BCN Medicare Advantage |
$74.64
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.64
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.92
|
| Rate for Payer: Mclaren Medicaid |
$52.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.37
|
| Rate for Payer: Meridian Medicaid |
$55.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.92
|
| Rate for Payer: PACE Senior Care Partners |
$70.91
|
| Rate for Payer: PACE SWMI |
$74.64
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: PHP Medicare Advantage |
$74.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$259.75
|
| Rate for Payer: Priority Health Medicare |
$75.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.80
|
| Rate for Payer: Railroad Medicare Medicare |
$74.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$249.30
|
| Rate for Payer: UHC Exchange |
$74.64
|
| Rate for Payer: UHC Medicaid |
$52.64
|
| Rate for Payer: UHC Medicare Advantage |
$74.64
|
| Rate for Payer: UHCCP Medicaid |
$52.64
|
| Rate for Payer: VA VA |
$74.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.92
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$367.20
|
|
|
Service Code
|
NDC 00904726361
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$330.48 |
| Rate for Payer: Aetna Commercial |
$312.12
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.75
|
| Rate for Payer: BCBS Complete |
$67.97
|
| Rate for Payer: BCBS MAPPO |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$301.88
|
| Rate for Payer: BCN Commercial |
$301.88
|
| Rate for Payer: BCN Medicare Advantage |
$91.80
|
| Rate for Payer: Cash Price |
$293.76
|
| Rate for Payer: Cofinity Commercial |
$315.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.80
|
| Rate for Payer: Healthscope Commercial |
$330.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.40
|
| Rate for Payer: Mclaren Medicaid |
$64.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.39
|
| Rate for Payer: Meridian Medicaid |
$67.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.12
|
| Rate for Payer: Nomi Health Commercial |
$301.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.40
|
| Rate for Payer: PACE Senior Care Partners |
$87.21
|
| Rate for Payer: PACE SWMI |
$91.80
|
| Rate for Payer: PHP Commercial |
$312.12
|
| Rate for Payer: PHP Medicare Advantage |
$91.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$319.46
|
| Rate for Payer: Priority Health Medicare |
$92.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.57
|
| Rate for Payer: Railroad Medicare Medicare |
$91.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.14
|
| Rate for Payer: UHC Core |
$306.61
|
| Rate for Payer: UHC Exchange |
$91.80
|
| Rate for Payer: UHC Medicaid |
$64.74
|
| Rate for Payer: UHC Medicare Advantage |
$91.80
|
| Rate for Payer: UHCCP Medicaid |
$64.74
|
| Rate for Payer: VA VA |
$91.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.40
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$83.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.64
|
| Rate for Payer: BCBS Complete |
$59.61
|
| Rate for Payer: BCBS MAPPO |
$80.51
|
| Rate for Payer: BCBS Trust/PPO |
$264.76
|
| Rate for Payer: BCN Commercial |
$264.76
|
| Rate for Payer: BCN Medicare Advantage |
$80.51
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.51
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Mclaren Medicaid |
$56.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.54
|
| Rate for Payer: Meridian Medicaid |
$59.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: PACE Senior Care Partners |
$76.49
|
| Rate for Payer: PACE SWMI |
$80.51
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: PHP Medicare Advantage |
$80.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.18
|
| Rate for Payer: Priority Health Medicare |
$81.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.15
|
| Rate for Payer: Railroad Medicare Medicare |
$80.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.40
|
| Rate for Payer: UHC Core |
$268.91
|
| Rate for Payer: UHC Exchange |
$80.51
|
| Rate for Payer: UHC Medicaid |
$56.78
|
| Rate for Payer: UHC Medicare Advantage |
$80.51
|
| Rate for Payer: UHCCP Medicaid |
$56.78
|
| Rate for Payer: VA VA |
$80.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$408.50
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: Aetna Medicare |
$106.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.66
|
| Rate for Payer: BCBS Complete |
$75.61
|
| Rate for Payer: BCBS MAPPO |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$335.83
|
| Rate for Payer: BCN Commercial |
$335.83
|
| Rate for Payer: BCN Medicare Advantage |
$102.12
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.12
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Mclaren Medicaid |
$72.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.23
|
| Rate for Payer: Meridian Medicaid |
$75.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$112.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: PACE Senior Care Partners |
$97.02
|
| Rate for Payer: PACE SWMI |
$102.12
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: PHP Medicare Advantage |
$102.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$72.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$355.39
|
| Rate for Payer: Priority Health Medicare |
$103.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.32
|
| Rate for Payer: Railroad Medicare Medicare |
$102.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.48
|
| Rate for Payer: UHC Core |
$341.10
|
| Rate for Payer: UHC Exchange |
$102.12
|
| Rate for Payer: UHC Medicaid |
$72.02
|
| Rate for Payer: UHC Medicare Advantage |
$102.12
|
| Rate for Payer: UHCCP Medicaid |
$72.02
|
| Rate for Payer: VA VA |
$102.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.38
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.15 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: BCBS Trust/PPO |
$265.98
|
| Rate for Payer: BCN Commercial |
$265.98
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$280.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.40
|
| Rate for Payer: UHC Core |
$268.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.32 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$347.23
|
| Rate for Payer: BCBS Trust/PPO |
$337.38
|
| Rate for Payer: BCN Commercial |
$337.38
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$351.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$367.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: PHP Commercial |
$347.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$355.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$284.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.48
|
| Rate for Payer: UHC Core |
$341.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.38
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.28
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Mclaren Medicaid |
$0.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$0.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.56
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicaid |
$0.72
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: UHCCP Medicaid |
$0.72
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.85 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.27
|
| Rate for Payer: BCN Commercial |
$155.27
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$48.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.75
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$154.55
|
| Rate for Payer: BCN Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Mclaren Medicaid |
$33.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: Meridian Medicaid |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE Senior Care Partners |
$44.65
|
| Rate for Payer: PACE SWMI |
$47.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: Railroad Medicare Medicare |
$47.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$33.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: UHCCP Medicaid |
$33.14
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$679.68
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$473.06 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: BCBS Trust/PPO |
$561.35
|
| Rate for Payer: BCN Commercial |
$561.35
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Nomi Health Commercial |
$557.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$591.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.12
|
| Rate for Payer: UHC Core |
$567.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$309.47
|
|
|
Service Code
|
NDC 00904657004
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$263.05
|
| Rate for Payer: Aetna Medicare |
$80.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.71
|
| Rate for Payer: BCBS Complete |
$57.28
|
| Rate for Payer: BCBS MAPPO |
$77.37
|
| Rate for Payer: BCBS Trust/PPO |
$254.42
|
| Rate for Payer: BCN Commercial |
$254.42
|
| Rate for Payer: BCN Medicare Advantage |
$77.37
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.37
|
| Rate for Payer: Healthscope Commercial |
$278.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.10
|
| Rate for Payer: Mclaren Medicaid |
$54.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.24
|
| Rate for Payer: Meridian Medicaid |
$57.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$85.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.05
|
| Rate for Payer: Nomi Health Commercial |
$253.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.10
|
| Rate for Payer: PACE Senior Care Partners |
$73.50
|
| Rate for Payer: PACE SWMI |
$77.37
|
| Rate for Payer: PHP Commercial |
$263.05
|
| Rate for Payer: PHP Medicare Advantage |
$77.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.24
|
| Rate for Payer: Priority Health Medicare |
$78.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.39
|
| Rate for Payer: Railroad Medicare Medicare |
$77.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.33
|
| Rate for Payer: UHC Core |
$258.41
|
| Rate for Payer: UHC Exchange |
$77.37
|
| Rate for Payer: UHC Medicaid |
$54.56
|
| Rate for Payer: UHC Medicare Advantage |
$77.37
|
| Rate for Payer: UHCCP Medicaid |
$54.56
|
| Rate for Payer: VA VA |
$77.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.10
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$309.47
|
|
|
Service Code
|
NDC 00904657004
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$215.39 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$263.05
|
| Rate for Payer: BCBS Trust/PPO |
$255.59
|
| Rate for Payer: BCN Commercial |
$255.59
|
| Rate for Payer: Cash Price |
$247.58
|
| Rate for Payer: Cofinity Commercial |
$266.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.58
|
| Rate for Payer: Healthscope Commercial |
$278.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.05
|
| Rate for Payer: Nomi Health Commercial |
$253.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.10
|
| Rate for Payer: PHP Commercial |
$263.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$269.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.33
|
| Rate for Payer: UHC Core |
$258.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.10
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$679.68
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.83 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: Aetna Medicare |
$176.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$212.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$212.40
|
| Rate for Payer: BCBS Complete |
$125.81
|
| Rate for Payer: BCBS MAPPO |
$169.92
|
| Rate for Payer: BCBS Trust/PPO |
$558.76
|
| Rate for Payer: BCN Commercial |
$558.76
|
| Rate for Payer: BCN Medicare Advantage |
$169.92
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.92
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: Mclaren Medicaid |
$119.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.42
|
| Rate for Payer: Meridian Medicaid |
$125.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Nomi Health Commercial |
$557.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: PACE Senior Care Partners |
$161.42
|
| Rate for Payer: PACE SWMI |
$169.92
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: PHP Medicare Advantage |
$169.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$591.32
|
| Rate for Payer: Priority Health Medicare |
$171.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$473.06
|
| Rate for Payer: Railroad Medicare Medicare |
$169.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.12
|
| Rate for Payer: UHC Core |
$567.53
|
| Rate for Payer: UHC Exchange |
$169.92
|
| Rate for Payer: UHC Medicaid |
$119.83
|
| Rate for Payer: UHC Medicare Advantage |
$169.92
|
| Rate for Payer: UHCCP Medicaid |
$119.83
|
| Rate for Payer: VA VA |
$169.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$7.93
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: BCBS Trust/PPO |
$6.55
|
| Rate for Payer: BCN Commercial |
$6.55
|
| Rate for Payer: Cash Price |
$6.34
|
| 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: Lakeland Regional Health Systems Commercial |
$5.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.74
|
| Rate for Payer: Nomi Health Commercial |
$6.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.95
|
| Rate for Payer: PHP Commercial |
$6.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.98
|
| Rate for Payer: UHC Core |
$6.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.95
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.34 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: BCBS Trust/PPO |
$187.89
|
| Rate for Payer: BCN Commercial |
$187.89
|
| Rate for Payer: Cash Price |
$182.00
|
| 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: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Nomi Health Commercial |
$186.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.20
|
| Rate for Payer: UHC Core |
$189.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$792.75
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.76 |
| Max. Negotiated Rate |
$713.48 |
| Rate for Payer: Aetna Commercial |
$673.84
|
| Rate for Payer: Aetna Medicare |
$206.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$247.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$247.73
|
| Rate for Payer: BCBS Complete |
$146.74
|
| Rate for Payer: BCBS MAPPO |
$198.19
|
| Rate for Payer: BCBS Trust/PPO |
$651.72
|
| Rate for Payer: BCN Commercial |
$651.72
|
| Rate for Payer: BCN Medicare Advantage |
$198.19
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cofinity Commercial |
$681.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.19
|
| Rate for Payer: Healthscope Commercial |
$713.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.56
|
| Rate for Payer: Mclaren Medicaid |
$139.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.10
|
| Rate for Payer: Meridian Medicaid |
$146.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.84
|
| Rate for Payer: Nomi Health Commercial |
$650.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.56
|
| Rate for Payer: PACE Senior Care Partners |
$188.28
|
| Rate for Payer: PACE SWMI |
$198.19
|
| Rate for Payer: PHP Commercial |
$673.84
|
| Rate for Payer: PHP Medicare Advantage |
$198.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$689.69
|
| Rate for Payer: Priority Health Medicare |
$200.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.75
|
| Rate for Payer: Railroad Medicare Medicare |
$198.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.62
|
| Rate for Payer: UHC Core |
$661.95
|
| Rate for Payer: UHC Exchange |
$198.19
|
| Rate for Payer: UHC Medicaid |
$139.76
|
| Rate for Payer: UHC Medicare Advantage |
$198.19
|
| Rate for Payer: UHCCP Medicaid |
$139.76
|
| Rate for Payer: VA VA |
$198.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$610.75
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.08 |
| Max. Negotiated Rate |
$549.67 |
| Rate for Payer: Aetna Commercial |
$519.14
|
| Rate for Payer: BCBS Trust/PPO |
$504.42
|
| Rate for Payer: BCN Commercial |
$504.42
|
| Rate for Payer: Cash Price |
$488.60
|
| 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: Lakeland Regional Health Systems Commercial |
$458.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.14
|
| Rate for Payer: Nomi Health Commercial |
$500.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.06
|
| Rate for Payer: PHP Commercial |
$519.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$531.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$425.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$537.46
|
| Rate for Payer: UHC Core |
$509.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.06
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$610.75
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.68 |
| Max. Negotiated Rate |
$549.67 |
| Rate for Payer: Aetna Commercial |
$519.14
|
| Rate for Payer: Aetna Medicare |
$158.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$190.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$190.86
|
| Rate for Payer: BCBS Complete |
$113.05
|
| Rate for Payer: BCBS MAPPO |
$152.69
|
| Rate for Payer: BCBS Trust/PPO |
$502.10
|
| Rate for Payer: BCN Commercial |
$502.10
|
| Rate for Payer: BCN Medicare Advantage |
$152.69
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: Cofinity Commercial |
$525.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.69
|
| Rate for Payer: Healthscope Commercial |
$549.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.06
|
| Rate for Payer: Mclaren Medicaid |
$107.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.32
|
| Rate for Payer: Meridian Medicaid |
$113.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.14
|
| Rate for Payer: Nomi Health Commercial |
$500.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.06
|
| Rate for Payer: PACE Senior Care Partners |
$145.05
|
| Rate for Payer: PACE SWMI |
$152.69
|
| Rate for Payer: PHP Commercial |
$519.14
|
| Rate for Payer: PHP Medicare Advantage |
$152.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$531.35
|
| Rate for Payer: Priority Health Medicare |
$154.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$425.08
|
| Rate for Payer: Railroad Medicare Medicare |
$152.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$537.46
|
| Rate for Payer: UHC Core |
$509.98
|
| Rate for Payer: UHC Exchange |
$152.69
|
| Rate for Payer: UHC Medicaid |
$107.68
|
| Rate for Payer: UHC Medicare Advantage |
$152.69
|
| Rate for Payer: UHCCP Medicaid |
$107.68
|
| Rate for Payer: VA VA |
$152.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.06
|
|
