|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.75 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$505.75
|
| Rate for Payer: BCBS Trust/PPO |
$485.70
|
| Rate for Payer: BCN Commercial |
$459.82
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$511.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.00
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.75
|
| Rate for Payer: Nomi Health Commercial |
$487.90
|
| Rate for Payer: PHP Commercial |
$505.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.75
|
| Rate for Payer: Priority Health HMO/PPO |
$517.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.60
|
| Rate for Payer: UHC Core |
$496.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.25
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$285.25
|
|
|
Service Code
|
NDC 42806000501
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.41 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Aetna Commercial |
$242.46
|
| Rate for Payer: BCBS Trust/PPO |
$232.85
|
| 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 Commercial |
$242.46
|
| Rate for Payer: Nomi Health Commercial |
$233.90
|
| Rate for Payer: PHP Commercial |
$242.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.41
|
| Rate for Payer: Priority Health HMO/PPO |
$248.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.12
|
| 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
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: BCBS Trust/PPO |
$185.71
|
| Rate for Payer: BCN Commercial |
$175.81
|
| 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: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.88
|
| Rate for Payer: Priority Health HMO/PPO |
$197.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.42
|
| 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
|
$654.50
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.44 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.32
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.53
|
| Rate for Payer: BCBS Complete |
$261.80
|
| Rate for Payer: BCBS MAPPO |
$163.62
|
| Rate for Payer: BCBS Trust/PPO |
$538.06
|
| Rate for Payer: BCN Commercial |
$508.87
|
| Rate for Payer: BCN Medicare Advantage |
$163.62
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.62
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.32
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: PACE Senior Care Partners |
$155.44
|
| Rate for Payer: PACE SWMI |
$163.62
|
| Rate for Payer: PHP Commercial |
$556.32
|
| Rate for Payer: PHP Medicare Advantage |
$163.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.42
|
| Rate for Payer: Priority Health HMO/PPO |
$569.42
|
| Rate for Payer: Priority Health Medicare |
$165.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: Railroad Medicare Medicare |
$163.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.96
|
| Rate for Payer: UHC Core |
$546.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.62
|
| Rate for Payer: UHC Exchange |
$163.62
|
| Rate for Payer: UHC Medicare Advantage |
$163.62
|
| Rate for Payer: VA VA |
$163.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.65 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: BCBS Trust/PPO |
$359.99
|
| Rate for Payer: BCN Commercial |
$340.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: Nomi Health Commercial |
$361.62
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO |
$383.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.08
|
| Rate for Payer: UHC Core |
$368.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$654.50
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.42 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.32
|
| Rate for Payer: BCBS Trust/PPO |
$534.27
|
| Rate for Payer: BCN Commercial |
$505.80
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.32
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: PHP Commercial |
$556.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.42
|
| Rate for Payer: Priority Health HMO/PPO |
$569.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.96
|
| Rate for Payer: UHC Core |
$546.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$285.25
|
|
|
Service Code
|
NDC 42806000501
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.75 |
| Max. Negotiated Rate |
$256.72 |
| Rate for Payer: Aetna Commercial |
$242.46
|
| Rate for Payer: Aetna Medicare |
$74.16
|
| 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 |
$114.10
|
| Rate for Payer: BCBS MAPPO |
$71.31
|
| Rate for Payer: BCBS Trust/PPO |
$234.50
|
| Rate for Payer: BCN Commercial |
$221.78
|
| Rate for Payer: BCN Medicare Advantage |
$71.31
|
| 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: Health Alliance Plan Medicare Advantage |
$71.31
|
| Rate for Payer: Healthscope Commercial |
$256.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.46
|
| Rate for Payer: Nomi Health Commercial |
$233.90
|
| 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 Cigna Priority Health |
$185.41
|
| Rate for Payer: Priority Health HMO/PPO |
$248.17
|
| Rate for Payer: Priority Health Medicare |
$72.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.12
|
| 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 Dual Complete DSNP |
$71.31
|
| Rate for Payer: UHC Exchange |
$71.31
|
| Rate for Payer: UHC Medicare Advantage |
$71.31
|
| Rate for Payer: VA VA |
$71.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.94
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$5.95
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.86
|
| Rate for Payer: BCN Commercial |
$4.60
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cofinity Commercial |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.76
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.06
|
| Rate for Payer: Nomi Health Commercial |
$4.88
|
| Rate for Payer: PHP Commercial |
$5.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health HMO/PPO |
$5.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.24
|
| Rate for Payer: UHC Core |
$4.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.46
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.74 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna Medicare |
$114.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.81
|
| Rate for Payer: BCBS Complete |
$176.40
|
| Rate for Payer: BCBS MAPPO |
$110.25
|
| Rate for Payer: BCBS Trust/PPO |
$362.55
|
| Rate for Payer: BCN Commercial |
$342.88
|
| Rate for Payer: BCN Medicare Advantage |
$110.25
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.25
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: Nomi Health Commercial |
$361.62
|
| Rate for Payer: PACE Senior Care Partners |
$104.74
|
| Rate for Payer: PACE SWMI |
$110.25
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: PHP Medicare Advantage |
$110.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO |
$383.67
|
| Rate for Payer: Priority Health Medicare |
$111.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.47
|
| Rate for Payer: Railroad Medicare Medicare |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.08
|
| Rate for Payer: UHC Core |
$368.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.25
|
| Rate for Payer: UHC Exchange |
$110.25
|
| Rate for Payer: UHC Medicare Advantage |
$110.25
|
| Rate for Payer: VA VA |
$110.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.31 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$505.75
|
| Rate for Payer: Aetna Medicare |
$154.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$185.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$185.94
|
| Rate for Payer: BCBS Complete |
$238.00
|
| Rate for Payer: BCBS MAPPO |
$148.75
|
| Rate for Payer: BCBS Trust/PPO |
$489.15
|
| Rate for Payer: BCN Commercial |
$462.61
|
| Rate for Payer: BCN Medicare Advantage |
$148.75
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$511.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$476.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.75
|
| Rate for Payer: Healthscope Commercial |
$535.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$171.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.75
|
| Rate for Payer: Nomi Health Commercial |
$487.90
|
| Rate for Payer: PACE Senior Care Partners |
$141.31
|
| Rate for Payer: PACE SWMI |
$148.75
|
| Rate for Payer: PHP Commercial |
$505.75
|
| Rate for Payer: PHP Medicare Advantage |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$386.75
|
| Rate for Payer: Priority Health HMO/PPO |
$517.65
|
| Rate for Payer: Priority Health Medicare |
$150.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.65
|
| Rate for Payer: Railroad Medicare Medicare |
$148.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$523.60
|
| Rate for Payer: UHC Core |
$496.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.75
|
| Rate for Payer: UHC Exchange |
$148.75
|
| Rate for Payer: UHC Medicare Advantage |
$148.75
|
| Rate for Payer: VA VA |
$148.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.25
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$736.75
|
|
|
Service Code
|
NDC 42858000110
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.98 |
| Max. Negotiated Rate |
$663.08 |
| Rate for Payer: Aetna Commercial |
$626.24
|
| Rate for Payer: Aetna Medicare |
$191.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.23
|
| Rate for Payer: BCBS Complete |
$294.70
|
| Rate for Payer: BCBS MAPPO |
$184.19
|
| Rate for Payer: BCBS Trust/PPO |
$605.68
|
| Rate for Payer: BCN Commercial |
$572.82
|
| Rate for Payer: BCN Medicare Advantage |
$184.19
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: Cofinity Commercial |
$633.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.19
|
| Rate for Payer: Healthscope Commercial |
$663.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.24
|
| Rate for Payer: Nomi Health Commercial |
$604.14
|
| Rate for Payer: PACE Senior Care Partners |
$174.98
|
| Rate for Payer: PACE SWMI |
$184.19
|
| Rate for Payer: PHP Commercial |
$626.24
|
| Rate for Payer: PHP Medicare Advantage |
$184.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.89
|
| Rate for Payer: Priority Health HMO/PPO |
$640.97
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.62
|
| Rate for Payer: Railroad Medicare Medicare |
$184.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.34
|
| Rate for Payer: UHC Core |
$615.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.19
|
| Rate for Payer: UHC Exchange |
$184.19
|
| Rate for Payer: UHC Medicare Advantage |
$184.19
|
| Rate for Payer: VA VA |
$184.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$654.50
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.44 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.32
|
| Rate for Payer: Aetna Medicare |
$170.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$204.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$204.53
|
| Rate for Payer: BCBS Complete |
$261.80
|
| Rate for Payer: BCBS MAPPO |
$163.62
|
| Rate for Payer: BCBS Trust/PPO |
$538.06
|
| Rate for Payer: BCN Commercial |
$508.87
|
| Rate for Payer: BCN Medicare Advantage |
$163.62
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.62
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.32
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: PACE Senior Care Partners |
$155.44
|
| Rate for Payer: PACE SWMI |
$163.62
|
| Rate for Payer: PHP Commercial |
$556.32
|
| Rate for Payer: PHP Medicare Advantage |
$163.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.42
|
| Rate for Payer: Priority Health HMO/PPO |
$569.42
|
| Rate for Payer: Priority Health Medicare |
$165.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.52
|
| Rate for Payer: Railroad Medicare Medicare |
$163.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.96
|
| Rate for Payer: UHC Core |
$546.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.62
|
| Rate for Payer: UHC Exchange |
$163.62
|
| Rate for Payer: UHC Medicare Advantage |
$163.62
|
| Rate for Payer: VA VA |
$163.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$760.90
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$494.58 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Aetna Commercial |
$646.76
|
| Rate for Payer: BCBS Trust/PPO |
$621.12
|
| Rate for Payer: BCN Commercial |
$588.02
|
| Rate for Payer: Cash Price |
$608.72
|
| Rate for Payer: Cofinity Commercial |
$654.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.72
|
| Rate for Payer: Healthscope Commercial |
$684.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.76
|
| Rate for Payer: Nomi Health Commercial |
$623.94
|
| Rate for Payer: PHP Commercial |
$646.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.58
|
| Rate for Payer: Priority Health HMO/PPO |
$661.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$509.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.59
|
| Rate for Payer: UHC Core |
$635.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.68
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$9.64
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.01
|
| Rate for Payer: BCBS Complete |
$3.86
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCBS Trust/PPO |
$7.93
|
| Rate for Payer: BCN Commercial |
$7.50
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$8.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$7.90
|
| Rate for Payer: PACE Senior Care Partners |
$2.29
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Commercial |
$8.19
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.27
|
| Rate for Payer: Priority Health HMO/PPO |
$8.39
|
| Rate for Payer: Priority Health Medicare |
$2.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.48
|
| Rate for Payer: UHC Core |
$8.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Exchange |
$2.41
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
| Rate for Payer: VA VA |
$2.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.23
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$963.20
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$866.88 |
| Rate for Payer: Aetna Commercial |
$818.72
|
| Rate for Payer: Aetna Medicare |
$250.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.00
|
| Rate for Payer: BCBS Complete |
$385.28
|
| Rate for Payer: BCBS MAPPO |
$240.80
|
| Rate for Payer: BCBS Trust/PPO |
$791.85
|
| Rate for Payer: BCN Commercial |
$748.89
|
| Rate for Payer: BCN Medicare Advantage |
$240.80
|
| Rate for Payer: Cash Price |
$770.56
|
| Rate for Payer: Cofinity Commercial |
$828.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.80
|
| Rate for Payer: Healthscope Commercial |
$866.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.72
|
| Rate for Payer: Nomi Health Commercial |
$789.82
|
| Rate for Payer: PACE Senior Care Partners |
$228.76
|
| Rate for Payer: PACE SWMI |
$240.80
|
| Rate for Payer: PHP Commercial |
$818.72
|
| Rate for Payer: PHP Medicare Advantage |
$240.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.08
|
| Rate for Payer: Priority Health HMO/PPO |
$837.98
|
| Rate for Payer: Priority Health Medicare |
$243.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$645.34
|
| Rate for Payer: Railroad Medicare Medicare |
$240.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.62
|
| Rate for Payer: UHC Core |
$804.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.80
|
| Rate for Payer: UHC Exchange |
$240.80
|
| Rate for Payer: UHC Medicare Advantage |
$240.80
|
| Rate for Payer: VA VA |
$240.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.40
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$963.20
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$626.08 |
| Max. Negotiated Rate |
$866.88 |
| Rate for Payer: Aetna Commercial |
$818.72
|
| Rate for Payer: BCBS Trust/PPO |
$786.26
|
| Rate for Payer: BCN Commercial |
$744.36
|
| Rate for Payer: Cash Price |
$770.56
|
| Rate for Payer: Cofinity Commercial |
$828.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.56
|
| Rate for Payer: Healthscope Commercial |
$866.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.72
|
| Rate for Payer: Nomi Health Commercial |
$789.82
|
| Rate for Payer: PHP Commercial |
$818.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.08
|
| Rate for Payer: Priority Health HMO/PPO |
$837.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$645.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.62
|
| Rate for Payer: UHC Core |
$804.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.40
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$1,218.70
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$792.16 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$1,035.90
|
| Rate for Payer: BCBS Trust/PPO |
$994.82
|
| Rate for Payer: BCN Commercial |
$941.81
|
| Rate for Payer: Cash Price |
$974.96
|
| Rate for Payer: Cofinity Commercial |
$1,048.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.96
|
| Rate for Payer: Healthscope Commercial |
$1,096.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.90
|
| Rate for Payer: Nomi Health Commercial |
$999.33
|
| Rate for Payer: PHP Commercial |
$1,035.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.46
|
| Rate for Payer: UHC Core |
$1,017.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.02
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.75
|
| Rate for Payer: Healthscope Commercial |
$10.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.36
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: PHP Commercial |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health HMO/PPO |
$10.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.73
|
| Rate for Payer: UHC Core |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.14
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$760.90
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.71 |
| Max. Negotiated Rate |
$684.81 |
| Rate for Payer: Aetna Commercial |
$646.76
|
| Rate for Payer: Aetna Medicare |
$197.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$237.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$237.78
|
| Rate for Payer: BCBS Complete |
$304.36
|
| Rate for Payer: BCBS MAPPO |
$190.22
|
| Rate for Payer: BCBS Trust/PPO |
$625.54
|
| Rate for Payer: BCN Commercial |
$591.60
|
| Rate for Payer: BCN Medicare Advantage |
$190.22
|
| Rate for Payer: Cash Price |
$608.72
|
| Rate for Payer: Cofinity Commercial |
$654.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$608.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.22
|
| Rate for Payer: Healthscope Commercial |
$684.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$570.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.76
|
| Rate for Payer: Nomi Health Commercial |
$623.94
|
| Rate for Payer: PACE Senior Care Partners |
$180.71
|
| Rate for Payer: PACE SWMI |
$190.22
|
| Rate for Payer: PHP Commercial |
$646.76
|
| Rate for Payer: PHP Medicare Advantage |
$190.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$494.58
|
| Rate for Payer: Priority Health HMO/PPO |
$661.98
|
| Rate for Payer: Priority Health Medicare |
$192.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$509.80
|
| Rate for Payer: Railroad Medicare Medicare |
$190.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.59
|
| Rate for Payer: UHC Core |
$635.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.22
|
| Rate for Payer: UHC Exchange |
$190.22
|
| Rate for Payer: UHC Medicare Advantage |
$190.22
|
| Rate for Payer: VA VA |
$190.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$570.68
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$12.19
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.81
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.02
|
| Rate for Payer: BCN Commercial |
$9.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$10.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.36
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: PACE Senior Care Partners |
$2.90
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Commercial |
$10.36
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health HMO/PPO |
$10.61
|
| Rate for Payer: Priority Health Medicare |
$3.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.17
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.73
|
| Rate for Payer: UHC Core |
$10.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.05
|
| Rate for Payer: UHC Exchange |
$3.05
|
| Rate for Payer: UHC Medicare Advantage |
$3.05
|
| Rate for Payer: VA VA |
$3.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.14
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$1,218.70
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.44 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$1,035.90
|
| Rate for Payer: Aetna Medicare |
$316.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$380.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$380.84
|
| Rate for Payer: BCBS Complete |
$487.48
|
| Rate for Payer: BCBS MAPPO |
$304.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.89
|
| Rate for Payer: BCN Commercial |
$947.54
|
| Rate for Payer: BCN Medicare Advantage |
$304.68
|
| Rate for Payer: Cash Price |
$974.96
|
| Rate for Payer: Cofinity Commercial |
$1,048.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.68
|
| Rate for Payer: Healthscope Commercial |
$1,096.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$914.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$350.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.90
|
| Rate for Payer: Nomi Health Commercial |
$999.33
|
| Rate for Payer: PACE Senior Care Partners |
$289.44
|
| Rate for Payer: PACE SWMI |
$304.68
|
| Rate for Payer: PHP Commercial |
$1,035.90
|
| Rate for Payer: PHP Medicare Advantage |
$304.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.16
|
| Rate for Payer: Priority Health HMO/PPO |
$1,060.27
|
| Rate for Payer: Priority Health Medicare |
$307.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.53
|
| Rate for Payer: Railroad Medicare Medicare |
$304.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,072.46
|
| Rate for Payer: UHC Core |
$1,017.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$304.68
|
| Rate for Payer: UHC Exchange |
$304.68
|
| Rate for Payer: UHC Medicare Advantage |
$304.68
|
| Rate for Payer: VA VA |
$304.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$914.02
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$9.64
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.87
|
| Rate for Payer: BCN Commercial |
$7.45
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$8.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$7.90
|
| Rate for Payer: PHP Commercial |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.27
|
| Rate for Payer: Priority Health HMO/PPO |
$8.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.48
|
| Rate for Payer: UHC Core |
$8.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.23
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$6.53
|
|
|
Service Code
|
NDC 00406051223
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.04
|
| Rate for Payer: BCBS Complete |
$2.61
|
| Rate for Payer: BCBS MAPPO |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$5.37
|
| Rate for Payer: BCN Commercial |
$5.08
|
| Rate for Payer: BCN Medicare Advantage |
$1.63
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$5.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.63
|
| Rate for Payer: Healthscope Commercial |
$5.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.55
|
| Rate for Payer: Nomi Health Commercial |
$5.35
|
| Rate for Payer: PACE Senior Care Partners |
$1.55
|
| Rate for Payer: PACE SWMI |
$1.63
|
| Rate for Payer: PHP Commercial |
$5.55
|
| Rate for Payer: PHP Medicare Advantage |
$1.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.24
|
| Rate for Payer: Priority Health HMO/PPO |
$5.68
|
| Rate for Payer: Priority Health Medicare |
$1.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.75
|
| Rate for Payer: UHC Core |
$5.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.63
|
| Rate for Payer: UHC Exchange |
$1.63
|
| Rate for Payer: UHC Medicare Advantage |
$1.63
|
| Rate for Payer: VA VA |
$1.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.90
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
NDC 47781019601
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: BCBS Trust/PPO |
$159.99
|
| Rate for Payer: BCN Commercial |
$151.47
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$160.72
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO |
$170.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.48
|
| Rate for Payer: UHC Core |
$163.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
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 |
$414.05 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: Aetna Commercial |
$541.45
|
| Rate for Payer: BCBS Trust/PPO |
$519.98
|
| 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 Commercial |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$522.34
|
| Rate for Payer: PHP Commercial |
$541.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.05
|
| Rate for Payer: Priority Health HMO/PPO |
$554.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$426.79
|
| 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
|
|
