|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.43 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: BCBS Trust/PPO |
$53.29
|
| Rate for Payer: BCN Commercial |
$50.45
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.40
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: BCBS MAPPO |
$16.32
|
| Rate for Payer: BCBS Trust/PPO |
$53.67
|
| Rate for Payer: BCN Commercial |
$50.76
|
| Rate for Payer: BCN Medicare Advantage |
$16.32
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.32
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: Nomi Health Commercial |
$53.53
|
| Rate for Payer: PACE Senior Care Partners |
$15.50
|
| Rate for Payer: PACE SWMI |
$16.32
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: PHP Medicare Advantage |
$16.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health HMO/PPO |
$56.79
|
| Rate for Payer: Priority Health Medicare |
$16.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.45
|
| Rate for Payer: UHC Core |
$54.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.32
|
| Rate for Payer: UHC Exchange |
$16.32
|
| Rate for Payer: UHC Medicare Advantage |
$16.32
|
| Rate for Payer: VA VA |
$16.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
NDC 68084035511
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.29 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: Aetna Commercial |
$541.45
|
| Rate for Payer: Aetna Medicare |
$165.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$199.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$199.06
|
| Rate for Payer: BCBS Complete |
$254.80
|
| Rate for Payer: BCBS MAPPO |
$159.25
|
| Rate for Payer: BCBS Trust/PPO |
$523.68
|
| Rate for Payer: BCN Commercial |
$495.27
|
| Rate for Payer: BCN Medicare Advantage |
$159.25
|
| 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: Health Alliance Plan Medicare Advantage |
$159.25
|
| Rate for Payer: Healthscope Commercial |
$573.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$477.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$522.34
|
| Rate for Payer: PACE Senior Care Partners |
$151.29
|
| Rate for Payer: PACE SWMI |
$159.25
|
| Rate for Payer: PHP Commercial |
$541.45
|
| Rate for Payer: PHP Medicare Advantage |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.05
|
| Rate for Payer: Priority Health HMO/PPO |
$554.19
|
| Rate for Payer: Priority Health Medicare |
$160.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$426.79
|
| Rate for Payer: Railroad Medicare Medicare |
$159.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.56
|
| Rate for Payer: UHC Core |
$531.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.25
|
| Rate for Payer: UHC Exchange |
$159.25
|
| Rate for Payer: UHC Medicare Advantage |
$159.25
|
| Rate for Payer: VA VA |
$159.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$477.75
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$6.53
|
|
|
Service Code
|
NDC 00406051223
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: BCBS Trust/PPO |
$5.33
|
| Rate for Payer: BCN Commercial |
$5.05
|
| 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: Healthscope Commercial |
$5.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.55
|
| Rate for Payer: Nomi Health Commercial |
$5.35
|
| Rate for Payer: PHP Commercial |
$5.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.24
|
| Rate for Payer: Priority Health HMO/PPO |
$5.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.75
|
| Rate for Payer: UHC Core |
$5.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.90
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
NDC 47781019601
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$50.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.25
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$49.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.13
|
| Rate for Payer: BCN Commercial |
$152.39
|
| Rate for Payer: BCN Medicare Advantage |
$49.00
|
| 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: Health Alliance Plan Medicare Advantage |
$49.00
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$160.72
|
| Rate for Payer: PACE Senior Care Partners |
$46.55
|
| Rate for Payer: PACE SWMI |
$49.00
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: PHP Medicare Advantage |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO |
$170.52
|
| Rate for Payer: Priority Health Medicare |
$49.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.32
|
| Rate for Payer: Railroad Medicare Medicare |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.48
|
| Rate for Payer: UHC Core |
$163.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.00
|
| Rate for Payer: UHC Exchange |
$49.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.00
|
| Rate for Payer: VA VA |
$49.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$1,031.10
|
|
|
Service Code
|
NDC 00406052262
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.89 |
| Max. Negotiated Rate |
$927.99 |
| Rate for Payer: Aetna Commercial |
$876.44
|
| Rate for Payer: Aetna Medicare |
$268.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$322.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$322.22
|
| Rate for Payer: BCBS Complete |
$412.44
|
| Rate for Payer: BCBS MAPPO |
$257.78
|
| Rate for Payer: BCBS Trust/PPO |
$847.67
|
| Rate for Payer: BCN Commercial |
$801.68
|
| Rate for Payer: BCN Medicare Advantage |
$257.78
|
| Rate for Payer: Cash Price |
$824.88
|
| Rate for Payer: Cofinity Commercial |
$886.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.78
|
| Rate for Payer: Healthscope Commercial |
$927.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$296.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.44
|
| Rate for Payer: Nomi Health Commercial |
$845.50
|
| Rate for Payer: PACE Senior Care Partners |
$244.89
|
| Rate for Payer: PACE SWMI |
$257.78
|
| Rate for Payer: PHP Commercial |
$876.44
|
| Rate for Payer: PHP Medicare Advantage |
$257.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.22
|
| Rate for Payer: Priority Health HMO/PPO |
$897.06
|
| Rate for Payer: Priority Health Medicare |
$260.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$690.84
|
| Rate for Payer: Railroad Medicare Medicare |
$257.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.37
|
| Rate for Payer: UHC Core |
$860.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.78
|
| Rate for Payer: UHC Exchange |
$257.78
|
| Rate for Payer: UHC Medicare Advantage |
$257.78
|
| Rate for Payer: VA VA |
$257.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.32
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$10.32
|
|
|
Service Code
|
NDC 00406052223
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: BCBS Trust/PPO |
$8.42
|
| Rate for Payer: BCN Commercial |
$7.98
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.77
|
| Rate for Payer: Nomi Health Commercial |
$8.46
|
| Rate for Payer: PHP Commercial |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO |
$8.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.08
|
| Rate for Payer: UHC Core |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.74
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,031.10
|
|
|
Service Code
|
NDC 00406052262
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$670.22 |
| Max. Negotiated Rate |
$927.99 |
| Rate for Payer: Aetna Commercial |
$876.44
|
| Rate for Payer: BCBS Trust/PPO |
$841.69
|
| Rate for Payer: BCN Commercial |
$796.83
|
| Rate for Payer: Cash Price |
$824.88
|
| Rate for Payer: Cofinity Commercial |
$886.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.88
|
| Rate for Payer: Healthscope Commercial |
$927.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.44
|
| Rate for Payer: Nomi Health Commercial |
$845.50
|
| Rate for Payer: PHP Commercial |
$876.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.22
|
| Rate for Payer: Priority Health HMO/PPO |
$897.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$690.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$907.37
|
| Rate for Payer: UHC Core |
$860.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.32
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$10.32
|
|
|
Service Code
|
NDC 00406052223
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.22
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.48
|
| Rate for Payer: BCN Commercial |
$8.02
|
| Rate for Payer: BCN Medicare Advantage |
$2.58
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$9.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.77
|
| Rate for Payer: Nomi Health Commercial |
$8.46
|
| Rate for Payer: PACE Senior Care Partners |
$2.45
|
| Rate for Payer: PACE SWMI |
$2.58
|
| Rate for Payer: PHP Commercial |
$8.77
|
| Rate for Payer: PHP Medicare Advantage |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health HMO/PPO |
$8.98
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.91
|
| Rate for Payer: Railroad Medicare Medicare |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.08
|
| Rate for Payer: UHC Core |
$8.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.58
|
| Rate for Payer: UHC Exchange |
$2.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.74
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$325.65
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.34 |
| Max. Negotiated Rate |
$293.08 |
| Rate for Payer: Aetna Commercial |
$276.80
|
| Rate for Payer: Aetna Medicare |
$84.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.77
|
| Rate for Payer: BCBS Complete |
$130.26
|
| Rate for Payer: BCBS MAPPO |
$81.41
|
| Rate for Payer: BCBS Trust/PPO |
$267.72
|
| Rate for Payer: BCN Commercial |
$253.19
|
| Rate for Payer: BCN Medicare Advantage |
$81.41
|
| Rate for Payer: Cash Price |
$260.52
|
| Rate for Payer: Cofinity Commercial |
$280.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.41
|
| Rate for Payer: Healthscope Commercial |
$293.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.80
|
| Rate for Payer: Nomi Health Commercial |
$267.03
|
| Rate for Payer: PACE Senior Care Partners |
$77.34
|
| Rate for Payer: PACE SWMI |
$81.41
|
| Rate for Payer: PHP Commercial |
$276.80
|
| Rate for Payer: PHP Medicare Advantage |
$81.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.67
|
| Rate for Payer: Priority Health HMO/PPO |
$283.32
|
| Rate for Payer: Priority Health Medicare |
$82.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.19
|
| Rate for Payer: Railroad Medicare Medicare |
$81.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.57
|
| Rate for Payer: UHC Core |
$271.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.41
|
| Rate for Payer: UHC Exchange |
$81.41
|
| Rate for Payer: UHC Medicare Advantage |
$81.41
|
| Rate for Payer: VA VA |
$81.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.24
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$325.65
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.67 |
| Max. Negotiated Rate |
$293.08 |
| Rate for Payer: Aetna Commercial |
$276.80
|
| Rate for Payer: BCBS Trust/PPO |
$265.83
|
| Rate for Payer: BCN Commercial |
$251.66
|
| Rate for Payer: Cash Price |
$260.52
|
| Rate for Payer: Cofinity Commercial |
$280.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.52
|
| Rate for Payer: Healthscope Commercial |
$293.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.80
|
| Rate for Payer: Nomi Health Commercial |
$267.03
|
| Rate for Payer: PHP Commercial |
$276.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.67
|
| Rate for Payer: Priority Health HMO/PPO |
$283.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.57
|
| Rate for Payer: UHC Core |
$271.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.24
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$513.35
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.92 |
| Max. Negotiated Rate |
$462.02 |
| Rate for Payer: Aetna Commercial |
$436.35
|
| Rate for Payer: Aetna Medicare |
$133.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$160.42
|
| Rate for Payer: BCBS Complete |
$205.34
|
| Rate for Payer: BCBS MAPPO |
$128.34
|
| Rate for Payer: BCBS Trust/PPO |
$422.03
|
| Rate for Payer: BCN Commercial |
$399.13
|
| Rate for Payer: BCN Medicare Advantage |
$128.34
|
| Rate for Payer: Cash Price |
$410.68
|
| Rate for Payer: Cofinity Commercial |
$441.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.34
|
| Rate for Payer: Healthscope Commercial |
$462.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$147.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.35
|
| Rate for Payer: Nomi Health Commercial |
$420.95
|
| Rate for Payer: PACE Senior Care Partners |
$121.92
|
| Rate for Payer: PACE SWMI |
$128.34
|
| Rate for Payer: PHP Commercial |
$436.35
|
| Rate for Payer: PHP Medicare Advantage |
$128.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.68
|
| Rate for Payer: Priority Health HMO/PPO |
$446.61
|
| Rate for Payer: Priority Health Medicare |
$129.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.94
|
| Rate for Payer: Railroad Medicare Medicare |
$128.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.75
|
| Rate for Payer: UHC Core |
$428.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.34
|
| Rate for Payer: UHC Exchange |
$128.34
|
| Rate for Payer: UHC Medicare Advantage |
$128.34
|
| Rate for Payer: VA VA |
$128.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.01
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$513.35
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.68 |
| Max. Negotiated Rate |
$462.02 |
| Rate for Payer: Aetna Commercial |
$436.35
|
| Rate for Payer: BCBS Trust/PPO |
$419.05
|
| Rate for Payer: BCN Commercial |
$396.72
|
| Rate for Payer: Cash Price |
$410.68
|
| Rate for Payer: Cofinity Commercial |
$441.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.68
|
| Rate for Payer: Healthscope Commercial |
$462.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.35
|
| Rate for Payer: Nomi Health Commercial |
$420.95
|
| Rate for Payer: PHP Commercial |
$436.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.68
|
| Rate for Payer: Priority Health HMO/PPO |
$446.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$451.75
|
| Rate for Payer: UHC Core |
$428.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.01
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$878.86
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.73 |
| Max. Negotiated Rate |
$790.97 |
| Rate for Payer: Aetna Commercial |
$747.03
|
| Rate for Payer: Aetna Medicare |
$228.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.64
|
| Rate for Payer: BCBS Complete |
$351.54
|
| Rate for Payer: BCBS MAPPO |
$219.72
|
| Rate for Payer: BCBS Trust/PPO |
$722.51
|
| Rate for Payer: BCN Commercial |
$683.31
|
| Rate for Payer: BCN Medicare Advantage |
$219.72
|
| Rate for Payer: Cash Price |
$703.09
|
| Rate for Payer: Cofinity Commercial |
$755.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.72
|
| Rate for Payer: Healthscope Commercial |
$790.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.03
|
| Rate for Payer: Nomi Health Commercial |
$720.67
|
| Rate for Payer: PACE Senior Care Partners |
$208.73
|
| Rate for Payer: PACE SWMI |
$219.72
|
| Rate for Payer: PHP Commercial |
$747.03
|
| Rate for Payer: PHP Medicare Advantage |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.26
|
| Rate for Payer: Priority Health HMO/PPO |
$764.61
|
| Rate for Payer: Priority Health Medicare |
$221.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$588.84
|
| Rate for Payer: Railroad Medicare Medicare |
$219.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$773.40
|
| Rate for Payer: UHC Core |
$733.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.72
|
| Rate for Payer: UHC Exchange |
$219.72
|
| Rate for Payer: UHC Medicare Advantage |
$219.72
|
| Rate for Payer: VA VA |
$219.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.14
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$878.86
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$790.97 |
| Rate for Payer: Aetna Commercial |
$747.03
|
| Rate for Payer: BCBS Trust/PPO |
$717.41
|
| Rate for Payer: BCN Commercial |
$679.18
|
| Rate for Payer: Cash Price |
$703.09
|
| Rate for Payer: Cofinity Commercial |
$755.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.09
|
| Rate for Payer: Healthscope Commercial |
$790.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.03
|
| Rate for Payer: Nomi Health Commercial |
$720.67
|
| Rate for Payer: PHP Commercial |
$747.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.26
|
| Rate for Payer: Priority Health HMO/PPO |
$764.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$588.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$773.40
|
| Rate for Payer: UHC Core |
$733.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.14
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$5.22
|
|
|
Service Code
|
NDC 00904571130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.63
|
| Rate for Payer: BCBS Complete |
$2.09
|
| Rate for Payer: BCBS MAPPO |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.29
|
| Rate for Payer: BCN Commercial |
$4.06
|
| Rate for Payer: BCN Medicare Advantage |
$1.30
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Cofinity Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.30
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.44
|
| Rate for Payer: Nomi Health Commercial |
$4.28
|
| Rate for Payer: PACE Senior Care Partners |
$1.24
|
| Rate for Payer: PACE SWMI |
$1.30
|
| Rate for Payer: PHP Commercial |
$4.44
|
| Rate for Payer: PHP Medicare Advantage |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.39
|
| Rate for Payer: Priority Health HMO/PPO |
$4.54
|
| Rate for Payer: Priority Health Medicare |
$1.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.59
|
| Rate for Payer: UHC Core |
$4.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.30
|
| Rate for Payer: UHC Exchange |
$1.30
|
| Rate for Payer: UHC Medicare Advantage |
$1.30
|
| Rate for Payer: VA VA |
$1.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.69 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$33.52
|
| Rate for Payer: BCN Commercial |
$31.73
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: Nomi Health Commercial |
$33.67
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.69
|
| Rate for Payer: Priority Health HMO/PPO |
$35.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.13
|
| Rate for Payer: UHC Core |
$34.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.95
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS MAPPO |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$7.77
|
| Rate for Payer: BCN Commercial |
$7.35
|
| Rate for Payer: BCN Medicare Advantage |
$2.36
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.36
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: PACE Senior Care Partners |
$2.24
|
| Rate for Payer: PACE SWMI |
$2.36
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health HMO/PPO |
$8.22
|
| Rate for Payer: Priority Health Medicare |
$2.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.33
|
| Rate for Payer: Railroad Medicare Medicare |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.32
|
| Rate for Payer: UHC Core |
$7.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.36
|
| Rate for Payer: UHC Exchange |
$2.36
|
| Rate for Payer: UHC Medicare Advantage |
$2.36
|
| Rate for Payer: VA VA |
$2.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$16.20
|
|
|
Service Code
|
NDC 70000000101
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCN Commercial |
$12.52
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.26
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCN Commercial |
$10.22
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health HMO/PPO |
$11.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.64
|
| Rate for Payer: UHC Core |
$11.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$11.34
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.26
|
| Rate for Payer: BCN Commercial |
$8.76
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$9.30
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.37
|
| Rate for Payer: Priority Health HMO/PPO |
$9.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.98
|
| Rate for Payer: UHC Core |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.50
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$12.83
|
|
|
Service Code
|
NDC 00904742730
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$11.55 |
| Rate for Payer: Aetna Commercial |
$10.91
|
| Rate for Payer: BCBS Trust/PPO |
$10.47
|
| Rate for Payer: BCN Commercial |
$9.92
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.91
|
| Rate for Payer: Nomi Health Commercial |
$10.52
|
| Rate for Payer: PHP Commercial |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.34
|
| Rate for Payer: Priority Health HMO/PPO |
$11.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.29
|
| Rate for Payer: UHC Core |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$3.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.13
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: BCBS MAPPO |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$10.88
|
| Rate for Payer: BCN Commercial |
$10.29
|
| Rate for Payer: BCN Medicare Advantage |
$3.31
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Nomi Health Commercial |
$10.85
|
| Rate for Payer: PACE Senior Care Partners |
$3.14
|
| Rate for Payer: PACE SWMI |
$3.31
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: PHP Medicare Advantage |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health HMO/PPO |
$11.51
|
| Rate for Payer: Priority Health Medicare |
$3.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.86
|
| Rate for Payer: Railroad Medicare Medicare |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.64
|
| Rate for Payer: UHC Core |
$11.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.31
|
| Rate for Payer: UHC Exchange |
$3.31
|
| Rate for Payer: UHC Medicare Advantage |
$3.31
|
| Rate for Payer: VA VA |
$3.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 70000000101
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.06
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| Rate for Payer: BCN Commercial |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$4.05
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.05
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$13.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.85
|
| Rate for Payer: PACE SWMI |
$4.05
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: PHP Medicare Advantage |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health HMO/PPO |
$14.09
|
| Rate for Payer: Priority Health Medicare |
$4.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.85
|
| Rate for Payer: Railroad Medicare Medicare |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.26
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.05
|
| Rate for Payer: UHC Exchange |
$4.05
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
| Rate for Payer: VA VA |
$4.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$7.71
|
| Rate for Payer: BCN Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health HMO/PPO |
$8.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.32
|
| Rate for Payer: UHC Core |
$7.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
