|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.80 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: BCBS Trust/PPO |
$265.99
|
| Rate for Payer: BCN Commercial |
$251.82
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Nomi Health Commercial |
$267.20
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health HMO/PPO |
$283.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.75
|
| Rate for Payer: UHC Core |
$272.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.38 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$92.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.03
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS MAPPO |
$88.83
|
| Rate for Payer: BCBS Trust/PPO |
$292.09
|
| Rate for Payer: BCN Commercial |
$276.25
|
| Rate for Payer: BCN Medicare Advantage |
$88.83
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.83
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: PACE Senior Care Partners |
$84.38
|
| Rate for Payer: PACE SWMI |
$88.83
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: PHP Medicare Advantage |
$88.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health HMO/PPO |
$309.11
|
| Rate for Payer: Priority Health Medicare |
$89.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.05
|
| Rate for Payer: Railroad Medicare Medicare |
$88.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.66
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.83
|
| Rate for Payer: UHC Exchange |
$88.83
|
| Rate for Payer: UHC Medicare Advantage |
$88.83
|
| Rate for Payer: VA VA |
$88.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.37 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: BCBS Trust/PPO |
$246.60
|
| Rate for Payer: BCN Commercial |
$233.46
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| Rate for Payer: Priority Health HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.95
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS MAPPO |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.49
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.76
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.76
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PACE Senior Care Partners |
$0.72
|
| Rate for Payer: PACE SWMI |
$0.76
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Medicare |
$0.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.76
|
| Rate for Payer: UHC Exchange |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$0.76
|
| Rate for Payer: VA VA |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO |
$2.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.67
|
| Rate for Payer: UHC Core |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.39 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna Medicare |
$84.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.83
|
| Rate for Payer: BCBS Complete |
$130.34
|
| Rate for Payer: BCBS MAPPO |
$81.46
|
| Rate for Payer: BCBS Trust/PPO |
$267.88
|
| Rate for Payer: BCN Commercial |
$253.35
|
| Rate for Payer: BCN Medicare Advantage |
$81.46
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.46
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Nomi Health Commercial |
$267.20
|
| Rate for Payer: PACE Senior Care Partners |
$77.39
|
| Rate for Payer: PACE SWMI |
$81.46
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: PHP Medicare Advantage |
$81.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health HMO/PPO |
$283.49
|
| Rate for Payer: Priority Health Medicare |
$82.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.32
|
| Rate for Payer: Railroad Medicare Medicare |
$81.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.75
|
| Rate for Payer: UHC Core |
$272.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.46
|
| Rate for Payer: UHC Exchange |
$81.46
|
| Rate for Payer: UHC Medicare Advantage |
$81.46
|
| Rate for Payer: VA VA |
$81.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.94 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: BCBS Trust/PPO |
$290.03
|
| Rate for Payer: BCN Commercial |
$274.58
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health HMO/PPO |
$309.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.66
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.75 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare |
$78.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.41
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: BCBS MAPPO |
$75.53
|
| Rate for Payer: BCBS Trust/PPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$234.88
|
| Rate for Payer: BCN Medicare Advantage |
$75.53
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.53
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: PACE Senior Care Partners |
$71.75
|
| Rate for Payer: PACE SWMI |
$75.53
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: PHP Medicare Advantage |
$75.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| Rate for Payer: Priority Health HMO/PPO |
$262.83
|
| Rate for Payer: Priority Health Medicare |
$76.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.41
|
| Rate for Payer: Railroad Medicare Medicare |
$75.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.85
|
| Rate for Payer: UHC Core |
$252.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.53
|
| Rate for Payer: UHC Exchange |
$75.53
|
| Rate for Payer: UHC Medicare Advantage |
$75.53
|
| Rate for Payer: VA VA |
$75.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$252.20
|
|
|
Service Code
|
NDC 00904657004
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Aetna Commercial |
$214.37
|
| Rate for Payer: BCBS Trust/PPO |
$205.87
|
| Rate for Payer: BCN Commercial |
$194.90
|
| Rate for Payer: Cash Price |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$216.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.76
|
| Rate for Payer: Healthscope Commercial |
$226.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.37
|
| Rate for Payer: Nomi Health Commercial |
$206.80
|
| Rate for Payer: PHP Commercial |
$214.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.93
|
| Rate for Payer: Priority Health HMO/PPO |
$219.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.94
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.15
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$252.20
|
|
|
Service Code
|
NDC 00904657004
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$226.98 |
| Rate for Payer: Aetna Commercial |
$214.37
|
| Rate for Payer: Aetna Medicare |
$65.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.81
|
| Rate for Payer: BCBS Complete |
$100.88
|
| Rate for Payer: BCBS MAPPO |
$63.05
|
| Rate for Payer: BCBS Trust/PPO |
$207.33
|
| Rate for Payer: BCN Commercial |
$196.09
|
| Rate for Payer: BCN Medicare Advantage |
$63.05
|
| Rate for Payer: Cash Price |
$201.76
|
| Rate for Payer: Cofinity Commercial |
$216.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.05
|
| Rate for Payer: Healthscope Commercial |
$226.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.37
|
| Rate for Payer: Nomi Health Commercial |
$206.80
|
| Rate for Payer: PACE Senior Care Partners |
$59.90
|
| Rate for Payer: PACE SWMI |
$63.05
|
| Rate for Payer: PHP Commercial |
$214.37
|
| Rate for Payer: PHP Medicare Advantage |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.93
|
| Rate for Payer: Priority Health HMO/PPO |
$219.41
|
| Rate for Payer: Priority Health Medicare |
$63.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.97
|
| Rate for Payer: Railroad Medicare Medicare |
$63.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.94
|
| Rate for Payer: UHC Core |
$210.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.05
|
| Rate for Payer: UHC Exchange |
$63.05
|
| Rate for Payer: UHC Medicare Advantage |
$63.05
|
| Rate for Payer: VA VA |
$63.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.15
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.58 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare |
$58.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.50
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: BCBS MAPPO |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$185.47
|
| Rate for Payer: BCN Commercial |
$175.40
|
| Rate for Payer: BCN Medicare Advantage |
$56.40
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: PACE Senior Care Partners |
$53.58
|
| Rate for Payer: PACE SWMI |
$56.40
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health HMO/PPO |
$196.27
|
| Rate for Payer: Priority Health Medicare |
$56.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.15
|
| Rate for Payer: Railroad Medicare Medicare |
$56.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.40
|
| Rate for Payer: UHC Exchange |
$56.40
|
| Rate for Payer: UHC Medicare Advantage |
$56.40
|
| Rate for Payer: VA VA |
$56.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: BCBS Trust/PPO |
$184.16
|
| Rate for Payer: BCN Commercial |
$174.34
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health HMO/PPO |
$196.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.53
|
| Rate for Payer: UHC Core |
$188.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
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 |
$197.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.43
|
| 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
|
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
|
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 |
$556.33
|
| 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 |
$556.33
|
| 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 |
$556.33
|
| Rate for Payer: PHP Medicare Advantage |
$163.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.43
|
| Rate for Payer: Priority Health HMO/PPO |
$569.41
|
| Rate for Payer: Priority Health Medicare |
$165.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.51
|
| 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
|
$736.75
|
|
|
Service Code
|
NDC 42858000110
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.89 |
| Max. Negotiated Rate |
$663.08 |
| Rate for Payer: Aetna Commercial |
$626.24
|
| Rate for Payer: BCBS Trust/PPO |
$601.41
|
| Rate for Payer: BCN Commercial |
$569.36
|
| Rate for Payer: Cash Price |
$589.40
|
| Rate for Payer: Cofinity Commercial |
$633.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$589.40
|
| Rate for Payer: Healthscope Commercial |
$663.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$552.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$626.24
|
| Rate for Payer: Nomi Health Commercial |
$604.13
|
| Rate for Payer: PHP Commercial |
$626.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.89
|
| Rate for Payer: Priority Health HMO/PPO |
$640.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.34
|
| Rate for Payer: UHC Core |
$615.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$552.56
|
|
|
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 |
$256.73 |
| 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 |
$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 |
$245.31
|
| 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: 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 |
$233.91
|
| 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
|
$285.25
|
|
|
Service Code
|
NDC 42806000501
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.41 |
| Max. Negotiated Rate |
$256.73 |
| 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 |
$245.31
|
| 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: 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
|
OP
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.03 |
| 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 |
$91.00
|
| Rate for Payer: BCBS MAPPO |
$56.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.03
|
| Rate for Payer: BCN Commercial |
$176.88
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Nomi Health Commercial |
$186.55
|
| 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 Cigna Priority Health |
$147.88
|
| Rate for Payer: Priority Health HMO/PPO |
$197.93
|
| Rate for Payer: Priority Health Medicare |
$57.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.43
|
| 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 Dual Complete DSNP |
$56.88
|
| Rate for Payer: UHC Exchange |
$56.88
|
| Rate for Payer: UHC Medicare Advantage |
$56.88
|
| Rate for Payer: VA VA |
$56.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$5.95
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Aetna Commercial |
$5.06
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.86
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$4.89
|
| Rate for Payer: BCN Commercial |
$4.63
|
| Rate for Payer: BCN Medicare Advantage |
$1.49
|
| 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: Health Alliance Plan Medicare Advantage |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$5.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.06
|
| Rate for Payer: Nomi Health Commercial |
$4.88
|
| Rate for Payer: PACE Senior Care Partners |
$1.41
|
| Rate for Payer: PACE SWMI |
$1.49
|
| Rate for Payer: PHP Commercial |
$5.06
|
| Rate for Payer: PHP Medicare Advantage |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.87
|
| Rate for Payer: Priority Health HMO/PPO |
$5.18
|
| Rate for Payer: Priority Health Medicare |
$1.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.24
|
| Rate for Payer: UHC Core |
$4.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.49
|
| Rate for Payer: UHC Exchange |
$1.49
|
| Rate for Payer: UHC Medicare Advantage |
$1.49
|
| Rate for Payer: VA VA |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.46
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$654.50
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.43 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.33
|
| 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 |
$556.33
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.43
|
| Rate for Payer: Priority Health HMO/PPO |
$569.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.51
|
| 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
|
$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
|
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
|
$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 |
$556.33
|
| 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 |
$556.33
|
| 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 |
$556.33
|
| Rate for Payer: PHP Medicare Advantage |
$163.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.43
|
| Rate for Payer: Priority Health HMO/PPO |
$569.41
|
| Rate for Payer: Priority Health Medicare |
$165.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.51
|
| 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
|
$654.50
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$425.43 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna Commercial |
$556.33
|
| 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 |
$556.33
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: PHP Commercial |
$556.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.43
|
| Rate for Payer: Priority Health HMO/PPO |
$569.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$438.51
|
| 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
|
|
