|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$610.75
|
|
|
Service Code
|
NDC 68084035401
|
| 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 68084035411
|
| 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
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.11 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna Medicare |
$59.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.09
|
| Rate for Payer: BCBS Complete |
$42.11
|
| Rate for Payer: BCBS MAPPO |
$56.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.03
|
| Rate for Payer: BCN Commercial |
$187.03
|
| Rate for Payer: BCN Medicare Advantage |
$56.88
|
| 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: Health Alliance Plan Medicare Advantage |
$56.88
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Mclaren Medicaid |
$40.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.72
|
| Rate for Payer: Meridian Medicaid |
$42.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.56
|
| 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: PACE Senior Care Partners |
$54.03
|
| Rate for Payer: PACE SWMI |
$56.88
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: PHP Medicare Advantage |
$56.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$197.93
|
| Rate for Payer: Priority Health Medicare |
$57.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.34
|
| Rate for Payer: Railroad Medicare Medicare |
$56.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.20
|
| Rate for Payer: UHC Core |
$189.96
|
| Rate for Payer: UHC Exchange |
$56.88
|
| Rate for Payer: UHC Medicaid |
$40.11
|
| Rate for Payer: UHC Medicare Advantage |
$56.88
|
| Rate for Payer: UHCCP Medicaid |
$40.11
|
| Rate for Payer: VA VA |
$56.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$7.93
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.48
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.52
|
| Rate for Payer: BCN Commercial |
$6.52
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| 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: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$7.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.95
|
| Rate for Payer: Mclaren Medicaid |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.08
|
| Rate for Payer: Meridian Medicaid |
$1.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.18
|
| 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: PACE Senior Care Partners |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$6.74
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.90
|
| Rate for Payer: Priority Health Medicare |
$2.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.52
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.98
|
| Rate for Payer: UHC Core |
$6.62
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UHC Medicaid |
$1.40
|
| Rate for Payer: UHC Medicare Advantage |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.40
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.95
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$54.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.62
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS MAPPO |
$52.50
|
| Rate for Payer: BCBS Trust/PPO |
$172.64
|
| Rate for Payer: BCN Commercial |
$172.64
|
| Rate for Payer: BCN Medicare Advantage |
$52.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.50
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Mclaren Medicaid |
$37.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.12
|
| Rate for Payer: Meridian Medicaid |
$38.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE Senior Care Partners |
$49.88
|
| Rate for Payer: PACE SWMI |
$52.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: PHP Medicare Advantage |
$52.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.70
|
| Rate for Payer: Priority Health Medicare |
$53.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.16
|
| Rate for Payer: Railroad Medicare Medicare |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: UHC Exchange |
$52.50
|
| Rate for Payer: UHC Medicaid |
$37.02
|
| Rate for Payer: UHC Medicare Advantage |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$37.02
|
| Rate for Payer: VA VA |
$52.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: BCBS Trust/PPO |
$173.44
|
| Rate for Payer: BCN Commercial |
$173.44
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.80
|
| Rate for Payer: UHC Core |
$175.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$792.75
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$551.75 |
| Max. Negotiated Rate |
$713.48 |
| Rate for Payer: Aetna Commercial |
$673.84
|
| Rate for Payer: BCBS Trust/PPO |
$654.73
|
| Rate for Payer: BCN Commercial |
$654.73
|
| 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: Healthscope Commercial |
$713.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.56
|
| 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: PHP Commercial |
$673.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$689.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.62
|
| Rate for Payer: UHC Core |
$661.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$484.75
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.46 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna Medicare |
$126.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.48
|
| Rate for Payer: BCBS Complete |
$89.73
|
| Rate for Payer: BCBS MAPPO |
$121.19
|
| Rate for Payer: BCBS Trust/PPO |
$398.51
|
| Rate for Payer: BCN Commercial |
$398.51
|
| Rate for Payer: BCN Medicare Advantage |
$121.19
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.19
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: Mclaren Medicaid |
$85.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.25
|
| Rate for Payer: Meridian Medicaid |
$89.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Nomi Health Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PACE Senior Care Partners |
$115.13
|
| Rate for Payer: PACE SWMI |
$121.19
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: PHP Medicare Advantage |
$121.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$421.73
|
| Rate for Payer: Priority Health Medicare |
$122.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.39
|
| Rate for Payer: Railroad Medicare Medicare |
$121.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.58
|
| Rate for Payer: UHC Core |
$404.77
|
| Rate for Payer: UHC Exchange |
$121.19
|
| Rate for Payer: UHC Medicaid |
$85.46
|
| Rate for Payer: UHC Medicare Advantage |
$121.19
|
| Rate for Payer: UHCCP Medicaid |
$85.46
|
| Rate for Payer: VA VA |
$121.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$285.25
|
|
|
Service Code
|
NDC 42806000501
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.53 |
| Max. Negotiated Rate |
$256.73 |
| Rate for Payer: Aetna Commercial |
$242.46
|
| Rate for Payer: BCBS Trust/PPO |
$235.59
|
| Rate for Payer: BCN Commercial |
$235.59
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cofinity Commercial |
$245.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.20
|
| Rate for Payer: Healthscope Commercial |
$256.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.46
|
| Rate for Payer: Nomi Health Commercial |
$233.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.94
|
| Rate for Payer: PHP Commercial |
$242.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.53
|
| 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 5 MG TABLET
|
Facility
|
IP
|
$484.75
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.39 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: BCBS Trust/PPO |
$400.36
|
| Rate for Payer: BCN Commercial |
$400.36
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Nomi Health Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$421.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$337.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.58
|
| Rate for Payer: UHC Core |
$404.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$733.25
|
|
|
Service Code
|
NDC 42858000110
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$510.34 |
| Max. Negotiated Rate |
$659.92 |
| Rate for Payer: Aetna Commercial |
$623.26
|
| Rate for Payer: BCBS Trust/PPO |
$605.59
|
| Rate for Payer: BCN Commercial |
$605.59
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: Cofinity Commercial |
$630.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.60
|
| Rate for Payer: Healthscope Commercial |
$659.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.26
|
| Rate for Payer: Nomi Health Commercial |
$601.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.94
|
| Rate for Payer: PHP Commercial |
$623.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$637.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$510.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.26
|
| Rate for Payer: UHC Core |
$612.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.94
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$285.25
|
|
|
Service Code
|
NDC 42806000501
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$256.73 |
| Rate for Payer: Aetna Commercial |
$242.46
|
| Rate for Payer: Aetna Medicare |
$74.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.14
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$71.31
|
| Rate for Payer: BCBS Trust/PPO |
$234.50
|
| Rate for Payer: BCN Commercial |
$234.50
|
| Rate for Payer: BCN Medicare Advantage |
$71.31
|
| Rate for Payer: Cash Price |
$228.20
|
| Rate for Payer: Cofinity Commercial |
$245.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.31
|
| Rate for Payer: Healthscope Commercial |
$256.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.94
|
| Rate for Payer: Mclaren Medicaid |
$50.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.88
|
| Rate for Payer: Meridian Medicaid |
$52.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.46
|
| Rate for Payer: Nomi Health Commercial |
$233.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.94
|
| Rate for Payer: PACE Senior Care Partners |
$67.75
|
| Rate for Payer: PACE SWMI |
$71.31
|
| Rate for Payer: PHP Commercial |
$242.46
|
| Rate for Payer: PHP Medicare Advantage |
$71.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.17
|
| Rate for Payer: Priority Health Medicare |
$72.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.53
|
| Rate for Payer: Railroad Medicare Medicare |
$71.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.02
|
| Rate for Payer: UHC Core |
$238.18
|
| Rate for Payer: UHC Exchange |
$71.31
|
| Rate for Payer: UHC Medicaid |
$50.29
|
| Rate for Payer: UHC Medicare Advantage |
$71.31
|
| Rate for Payer: UHCCP Medicaid |
$50.29
|
| Rate for Payer: VA VA |
$71.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.94
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$733.25
|
|
|
Service Code
|
NDC 42858000110
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.27 |
| Max. Negotiated Rate |
$659.92 |
| Rate for Payer: Aetna Commercial |
$623.26
|
| Rate for Payer: Aetna Medicare |
$190.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.14
|
| Rate for Payer: BCBS Complete |
$135.72
|
| Rate for Payer: BCBS MAPPO |
$183.31
|
| Rate for Payer: BCBS Trust/PPO |
$602.80
|
| Rate for Payer: BCN Commercial |
$602.80
|
| Rate for Payer: BCN Medicare Advantage |
$183.31
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: Cofinity Commercial |
$630.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.31
|
| Rate for Payer: Healthscope Commercial |
$659.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.94
|
| Rate for Payer: Mclaren Medicaid |
$129.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.48
|
| Rate for Payer: Meridian Medicaid |
$135.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.26
|
| Rate for Payer: Nomi Health Commercial |
$601.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.94
|
| Rate for Payer: PACE Senior Care Partners |
$174.15
|
| Rate for Payer: PACE SWMI |
$183.31
|
| Rate for Payer: PHP Commercial |
$623.26
|
| Rate for Payer: PHP Medicare Advantage |
$183.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$637.93
|
| Rate for Payer: Priority Health Medicare |
$185.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$510.34
|
| Rate for Payer: Railroad Medicare Medicare |
$183.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.26
|
| Rate for Payer: UHC Core |
$612.26
|
| Rate for Payer: UHC Exchange |
$183.31
|
| Rate for Payer: UHC Medicaid |
$129.27
|
| Rate for Payer: UHC Medicare Advantage |
$183.31
|
| Rate for Payer: UHCCP Medicaid |
$129.27
|
| Rate for Payer: VA VA |
$183.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.94
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$8.57
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$7.71 |
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Commercial |
$7.08
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.28
|
| Rate for Payer: Nomi Health Commercial |
$7.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.54
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$1,071.70
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.94 |
| Max. Negotiated Rate |
$964.53 |
| Rate for Payer: Aetna Commercial |
$910.95
|
| Rate for Payer: Aetna Medicare |
$278.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$334.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$334.91
|
| Rate for Payer: BCBS Complete |
$198.37
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCBS Trust/PPO |
$881.04
|
| Rate for Payer: BCN Commercial |
$881.04
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: Cash Price |
$857.36
|
| Rate for Payer: Cofinity Commercial |
$921.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Healthscope Commercial |
$964.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.77
|
| Rate for Payer: Mclaren Medicaid |
$188.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.32
|
| Rate for Payer: Meridian Medicaid |
$198.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$308.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$294.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.95
|
| Rate for Payer: Nomi Health Commercial |
$878.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.77
|
| Rate for Payer: PACE Senior Care Partners |
$254.53
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PHP Commercial |
$910.95
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$932.38
|
| Rate for Payer: Priority Health Medicare |
$270.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.90
|
| Rate for Payer: Railroad Medicare Medicare |
$267.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$943.10
|
| Rate for Payer: UHC Core |
$894.87
|
| Rate for Payer: UHC Exchange |
$267.93
|
| Rate for Payer: UHC Medicaid |
$188.94
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
| Rate for Payer: UHCCP Medicaid |
$188.94
|
| Rate for Payer: VA VA |
$267.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.77
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$1,071.70
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.90 |
| Max. Negotiated Rate |
$964.53 |
| Rate for Payer: Aetna Commercial |
$910.95
|
| Rate for Payer: BCBS Trust/PPO |
$885.12
|
| Rate for Payer: BCN Commercial |
$885.12
|
| Rate for Payer: Cash Price |
$857.36
|
| Rate for Payer: Cofinity Commercial |
$921.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.36
|
| Rate for Payer: Healthscope Commercial |
$964.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.95
|
| Rate for Payer: Nomi Health Commercial |
$878.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.77
|
| Rate for Payer: PHP Commercial |
$910.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$932.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$943.10
|
| Rate for Payer: UHC Core |
$894.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.77
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$856.05
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna Commercial |
$727.64
|
| Rate for Payer: Aetna Medicare |
$222.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$267.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$267.52
|
| Rate for Payer: BCBS Complete |
$158.45
|
| Rate for Payer: BCBS MAPPO |
$214.01
|
| Rate for Payer: BCBS Trust/PPO |
$703.76
|
| Rate for Payer: BCN Commercial |
$703.76
|
| Rate for Payer: BCN Medicare Advantage |
$214.01
|
| Rate for Payer: Cash Price |
$684.84
|
| Rate for Payer: Cofinity Commercial |
$736.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.01
|
| Rate for Payer: Healthscope Commercial |
$770.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.04
|
| Rate for Payer: Mclaren Medicaid |
$150.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.71
|
| Rate for Payer: Meridian Medicaid |
$158.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$235.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.64
|
| Rate for Payer: Nomi Health Commercial |
$701.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.04
|
| Rate for Payer: PACE Senior Care Partners |
$203.31
|
| Rate for Payer: PACE SWMI |
$214.01
|
| Rate for Payer: PHP Commercial |
$727.64
|
| Rate for Payer: PHP Medicare Advantage |
$214.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$744.76
|
| Rate for Payer: Priority Health Medicare |
$216.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$214.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$753.32
|
| Rate for Payer: UHC Core |
$714.80
|
| Rate for Payer: UHC Exchange |
$214.01
|
| Rate for Payer: UHC Medicaid |
$150.92
|
| Rate for Payer: UHC Medicare Advantage |
$214.01
|
| Rate for Payer: UHCCP Medicaid |
$150.92
|
| Rate for Payer: VA VA |
$214.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.04
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$974.40
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$678.18 |
| Max. Negotiated Rate |
$876.96 |
| Rate for Payer: Aetna Commercial |
$828.24
|
| Rate for Payer: BCBS Trust/PPO |
$804.76
|
| Rate for Payer: BCN Commercial |
$804.76
|
| Rate for Payer: Cash Price |
$779.52
|
| Rate for Payer: Cofinity Commercial |
$837.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.52
|
| Rate for Payer: Healthscope Commercial |
$876.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.24
|
| Rate for Payer: Nomi Health Commercial |
$799.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$730.80
|
| Rate for Payer: PHP Commercial |
$828.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$847.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.47
|
| Rate for Payer: UHC Core |
$813.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.80
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Nomi Health Commercial |
$8.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.43
|
| Rate for Payer: UHC Core |
$8.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$974.40
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.79 |
| Max. Negotiated Rate |
$876.96 |
| Rate for Payer: Aetna Commercial |
$828.24
|
| Rate for Payer: Aetna Medicare |
$253.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$304.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$304.50
|
| Rate for Payer: BCBS Complete |
$180.36
|
| Rate for Payer: BCBS MAPPO |
$243.60
|
| Rate for Payer: BCBS Trust/PPO |
$801.05
|
| Rate for Payer: BCN Commercial |
$801.05
|
| Rate for Payer: BCN Medicare Advantage |
$243.60
|
| Rate for Payer: Cash Price |
$779.52
|
| Rate for Payer: Cofinity Commercial |
$837.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.60
|
| Rate for Payer: Healthscope Commercial |
$876.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.80
|
| Rate for Payer: Mclaren Medicaid |
$171.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.78
|
| Rate for Payer: Meridian Medicaid |
$180.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$267.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.24
|
| Rate for Payer: Nomi Health Commercial |
$799.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$730.80
|
| Rate for Payer: PACE Senior Care Partners |
$231.42
|
| Rate for Payer: PACE SWMI |
$243.60
|
| Rate for Payer: PHP Commercial |
$828.24
|
| Rate for Payer: PHP Medicare Advantage |
$243.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$171.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$847.73
|
| Rate for Payer: Priority Health Medicare |
$246.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$678.18
|
| Rate for Payer: Railroad Medicare Medicare |
$243.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.47
|
| Rate for Payer: UHC Core |
$813.62
|
| Rate for Payer: UHC Exchange |
$243.60
|
| Rate for Payer: UHC Medicaid |
$171.79
|
| Rate for Payer: UHC Medicare Advantage |
$243.60
|
| Rate for Payer: UHCCP Medicaid |
$171.79
|
| Rate for Payer: VA VA |
$243.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.80
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$8.57
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$7.71 |
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.68
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$7.05
|
| Rate for Payer: BCN Commercial |
$7.05
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: Mclaren Medicaid |
$1.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.28
|
| Rate for Payer: Nomi Health Commercial |
$7.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PACE Senior Care Partners |
$2.04
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$7.28
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.46
|
| Rate for Payer: Priority Health Medicare |
$2.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.96
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.54
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: UHC Exchange |
$2.14
|
| Rate for Payer: UHC Medicaid |
$1.51
|
| Rate for Payer: UHC Medicare Advantage |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$1.51
|
| Rate for Payer: VA VA |
$2.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$9.65 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.35
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS MAPPO |
$2.68
|
| Rate for Payer: BCBS Trust/PPO |
$8.81
|
| Rate for Payer: BCN Commercial |
$8.81
|
| Rate for Payer: BCN Medicare Advantage |
$2.68
|
| Rate for Payer: Cash Price |
$8.58
|
| Rate for Payer: Cofinity Commercial |
$9.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$9.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.04
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.81
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Nomi Health Commercial |
$8.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: PACE Senior Care Partners |
$2.55
|
| Rate for Payer: PACE SWMI |
$2.68
|
| Rate for Payer: PHP Commercial |
$9.11
|
| Rate for Payer: PHP Medicare Advantage |
$2.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.33
|
| Rate for Payer: Priority Health Medicare |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.43
|
| Rate for Payer: UHC Core |
$8.95
|
| Rate for Payer: UHC Exchange |
$2.68
|
| Rate for Payer: UHC Medicaid |
$1.89
|
| Rate for Payer: UHC Medicare Advantage |
$2.68
|
| Rate for Payer: UHCCP Medicaid |
$1.89
|
| Rate for Payer: VA VA |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.04
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$856.05
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$595.81 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna Commercial |
$727.64
|
| Rate for Payer: BCBS Trust/PPO |
$707.01
|
| Rate for Payer: BCN Commercial |
$707.01
|
| Rate for Payer: Cash Price |
$684.84
|
| Rate for Payer: Cofinity Commercial |
$736.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.84
|
| Rate for Payer: Healthscope Commercial |
$770.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.64
|
| Rate for Payer: Nomi Health Commercial |
$701.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.04
|
| Rate for Payer: PHP Commercial |
$727.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$744.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$753.32
|
| Rate for Payer: UHC Core |
$714.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.04
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$21.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS MAPPO |
$20.56
|
| Rate for Payer: BCBS Trust/PPO |
$67.62
|
| Rate for Payer: BCN Commercial |
$67.62
|
| Rate for Payer: BCN Medicare Advantage |
$20.56
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.56
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Mclaren Medicaid |
$14.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.59
|
| Rate for Payer: Meridian Medicaid |
$15.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PACE Senior Care Partners |
$19.53
|
| Rate for Payer: PACE SWMI |
$20.56
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: PHP Medicare Advantage |
$20.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.56
|
| Rate for Payer: Priority Health Medicare |
$20.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.25
|
| Rate for Payer: Railroad Medicare Medicare |
$20.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: UHC Exchange |
$20.56
|
| Rate for Payer: UHC Medicaid |
$14.50
|
| Rate for Payer: UHC Medicare Advantage |
$20.56
|
| Rate for Payer: UHCCP Medicaid |
$14.50
|
| Rate for Payer: VA VA |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: Aetna Commercial |
$541.45
|
| Rate for Payer: BCBS Trust/PPO |
$526.10
|
| Rate for Payer: BCN Commercial |
$526.10
|
| 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 Commercial |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$522.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$477.75
|
| Rate for Payer: PHP Commercial |
$541.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$554.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.56
|
| Rate for Payer: UHC Core |
$531.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.75
|
|
