|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$117.50
|
|
|
Service Code
|
NDC 0832-0038-00
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| Rate for Payer: Cofinity Commercial |
$82.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.00
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.88
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.25
|
| Rate for Payer: Priority Health SBD |
$74.02
|
| Rate for Payer: UMR Bronson Commercial |
$51.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 0832-0038-89
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Aetna American Axle |
$2.10
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.10
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.26
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 0904-2821-61
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.10
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084-400-11
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.71
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 0832-0038-01
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 0904-7027-61
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.20
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$118.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7.45
|
|
|
Service Code
|
NDC 50268-628-11
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna American Axle |
$4.84
|
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cofinity Commercial |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.96
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.33
|
| Rate for Payer: PHP Commercial |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.22
|
| Rate for Payer: Priority Health SBD |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.59
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$372.41
|
|
|
Service Code
|
NDC 50268-628-15
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna American Axle |
$242.07
|
| Rate for Payer: Aetna Commercial |
$316.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.07
|
| Rate for Payer: Cash Price |
$297.93
|
| Rate for Payer: Cofinity Commercial |
$260.69
|
| Rate for Payer: Cofinity Commercial |
$320.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.93
|
| Rate for Payer: Healthscope Commercial |
$335.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.55
|
| Rate for Payer: PHP Commercial |
$316.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.69
|
| Rate for Payer: Priority Health SBD |
$234.62
|
| Rate for Payer: UMR Bronson Commercial |
$163.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.31
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$561.12
|
|
|
Service Code
|
NDC 0904-6570-61
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.89 |
| Max. Negotiated Rate |
$505.01 |
| Rate for Payer: Aetna American Axle |
$364.73
|
| Rate for Payer: Aetna Commercial |
$476.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.73
|
| Rate for Payer: Cash Price |
$448.90
|
| Rate for Payer: Cofinity Commercial |
$392.78
|
| Rate for Payer: Cofinity Commercial |
$482.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.90
|
| Rate for Payer: Healthscope Commercial |
$505.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$392.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$420.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$476.95
|
| Rate for Payer: PHP Commercial |
$476.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.78
|
| Rate for Payer: Priority Health SBD |
$353.51
|
| Rate for Payer: UMR Bronson Commercial |
$246.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$420.84
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$705.25
|
|
|
Service Code
|
NDC 47781-264-01
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$634.72 |
| Rate for Payer: Aetna American Axle |
$458.41
|
| Rate for Payer: Aetna Commercial |
$599.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.41
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cofinity Commercial |
$493.68
|
| Rate for Payer: Cofinity Commercial |
$606.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.20
|
| Rate for Payer: Healthscope Commercial |
$634.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.46
|
| Rate for Payer: PHP Commercial |
$599.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.68
|
| Rate for Payer: Priority Health SBD |
$444.31
|
| Rate for Payer: UMR Bronson Commercial |
$310.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.94
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$318.50
|
|
|
Service Code
|
NDC 65162-049-10
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$286.65 |
| Rate for Payer: Aetna American Axle |
$207.02
|
| Rate for Payer: Aetna Commercial |
$270.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.02
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cofinity Commercial |
$222.95
|
| Rate for Payer: Cofinity Commercial |
$273.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.80
|
| Rate for Payer: Healthscope Commercial |
$286.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.72
|
| Rate for Payer: PHP Commercial |
$270.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.95
|
| Rate for Payer: Priority Health SBD |
$200.66
|
| Rate for Payer: UMR Bronson Commercial |
$140.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.88
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
NDC 0406-8515-01
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna American Axle |
$336.70
|
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.70
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$440.30
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.60
|
| Rate for Payer: Priority Health SBD |
$326.34
|
| Rate for Payer: UMR Bronson Commercial |
$227.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.50
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$339.50
|
|
|
Service Code
|
NDC 57664-187-88
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.38 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Aetna American Axle |
$220.68
|
| Rate for Payer: Aetna Commercial |
$288.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Cofinity Commercial |
$291.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.60
|
| Rate for Payer: Healthscope Commercial |
$305.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.58
|
| Rate for Payer: PHP Commercial |
$288.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.65
|
| Rate for Payer: Priority Health SBD |
$213.88
|
| Rate for Payer: UMR Bronson Commercial |
$149.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.62
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$227.50
|
|
|
Service Code
|
NDC 42858-003-01
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna American Axle |
$147.88
|
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.88
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$159.25
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$159.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.38
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UMR Bronson Commercial |
$100.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$631.75
|
|
|
Service Code
|
NDC 57664-224-88
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.97 |
| Max. Negotiated Rate |
$568.58 |
| Rate for Payer: Aetna American Axle |
$410.64
|
| Rate for Payer: Aetna Commercial |
$536.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.64
|
| Rate for Payer: Cash Price |
$505.40
|
| Rate for Payer: Cofinity Commercial |
$442.22
|
| Rate for Payer: Cofinity Commercial |
$543.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.40
|
| Rate for Payer: Healthscope Commercial |
$568.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$536.99
|
| Rate for Payer: PHP Commercial |
$536.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.22
|
| Rate for Payer: Priority Health SBD |
$398.00
|
| Rate for Payer: UMR Bronson Commercial |
$277.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
NDC 47781-265-01
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.28 |
| Max. Negotiated Rate |
$415.80 |
| Rate for Payer: Aetna American Axle |
$300.30
|
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$323.40
|
| Rate for Payer: Cofinity Commercial |
$397.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.60
|
| Rate for Payer: Healthscope Commercial |
$415.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$392.70
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.40
|
| Rate for Payer: Priority Health SBD |
$291.06
|
| Rate for Payer: UMR Bronson Commercial |
$203.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.50
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$729.75
|
|
|
Service Code
|
NDC 65162-051-10
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.09 |
| Max. Negotiated Rate |
$656.78 |
| Rate for Payer: Aetna American Axle |
$474.34
|
| Rate for Payer: Aetna Commercial |
$620.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.34
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$510.82
|
| Rate for Payer: Cofinity Commercial |
$627.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.80
|
| Rate for Payer: Healthscope Commercial |
$656.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$620.29
|
| Rate for Payer: PHP Commercial |
$620.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.82
|
| Rate for Payer: Priority Health SBD |
$459.74
|
| Rate for Payer: UMR Bronson Commercial |
$321.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.31
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$565.25
|
|
|
Service Code
|
NDC 10702-009-01
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.71 |
| Max. Negotiated Rate |
$508.72 |
| Rate for Payer: Aetna American Axle |
$367.41
|
| Rate for Payer: Aetna Commercial |
$480.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.41
|
| Rate for Payer: Cash Price |
$452.20
|
| Rate for Payer: Cofinity Commercial |
$395.68
|
| Rate for Payer: Cofinity Commercial |
$486.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.20
|
| Rate for Payer: Healthscope Commercial |
$508.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.46
|
| Rate for Payer: PHP Commercial |
$480.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.68
|
| Rate for Payer: Priority Health SBD |
$356.11
|
| Rate for Payer: UMR Bronson Commercial |
$248.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.94
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$799.75
|
|
|
Service Code
|
NDC 42806-008-01
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.89 |
| Max. Negotiated Rate |
$719.78 |
| Rate for Payer: Aetna American Axle |
$519.84
|
| Rate for Payer: Aetna Commercial |
$679.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.84
|
| Rate for Payer: Cash Price |
$639.80
|
| Rate for Payer: Cofinity Commercial |
$687.78
|
| Rate for Payer: Cofinity Commercial |
$559.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.80
|
| Rate for Payer: Healthscope Commercial |
$719.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$679.79
|
| Rate for Payer: PHP Commercial |
$679.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.82
|
| Rate for Payer: Priority Health SBD |
$503.84
|
| Rate for Payer: UMR Bronson Commercial |
$351.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 0406-8530-01
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cofinity Commercial |
$562.28
|
| Rate for Payer: Cofinity Commercial |
$690.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.60
|
| Rate for Payer: Healthscope Commercial |
$722.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$682.76
|
| Rate for Payer: PHP Commercial |
$682.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.28
|
| Rate for Payer: Priority Health SBD |
$506.05
|
| Rate for Payer: UMR Bronson Commercial |
$353.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.44
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$25.83
|
|
|
Service Code
|
NDC 0904-6828-94
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna American Axle |
$16.79
|
| Rate for Payer: Aetna Commercial |
$21.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.79
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$18.08
|
| Rate for Payer: Cofinity Commercial |
$22.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$23.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.96
|
| Rate for Payer: PHP Commercial |
$21.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.08
|
| Rate for Payer: Priority Health SBD |
$16.27
|
| Rate for Payer: UMR Bronson Commercial |
$11.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.37
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$647.50
|
|
|
Service Code
|
NDC 0904-6678-40
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna American Axle |
$420.88
|
| Rate for Payer: Aetna Commercial |
$550.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.88
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.00
|
| Rate for Payer: Healthscope Commercial |
$582.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$550.38
|
| Rate for Payer: PHP Commercial |
$550.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.25
|
| Rate for Payer: Priority Health SBD |
$407.92
|
| Rate for Payer: UMR Bronson Commercial |
$284.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.62
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$24.64
|
|
|
Service Code
|
NDC 0904-6828-05
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna American Axle |
$16.02
|
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$21.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.71
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.94
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.25
|
| Rate for Payer: Priority Health SBD |
$15.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.48
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$33.01
|
|
|
Service Code
|
NDC 0121-4827-05
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna American Axle |
$21.46
|
| Rate for Payer: Aetna Commercial |
$28.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.46
|
| Rate for Payer: Cash Price |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$23.11
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.41
|
| Rate for Payer: Healthscope Commercial |
$29.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.06
|
| Rate for Payer: PHP Commercial |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.11
|
| Rate for Payer: Priority Health SBD |
$20.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.76
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$33.01
|
|
|
Service Code
|
NDC 0121-4827-40
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$29.71 |
| Rate for Payer: Aetna American Axle |
$21.46
|
| Rate for Payer: Aetna Commercial |
$28.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.46
|
| Rate for Payer: Cash Price |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$23.11
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.41
|
| Rate for Payer: Healthscope Commercial |
$29.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.06
|
| Rate for Payer: PHP Commercial |
$28.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.11
|
| Rate for Payer: Priority Health SBD |
$20.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.76
|
|
