|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
NDC 47781-263-05
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$431.20 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Aetna American Axle |
$637.00
|
| Rate for Payer: Aetna Commercial |
$833.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cofinity Commercial |
$686.00
|
| Rate for Payer: Cofinity Commercial |
$842.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$784.00
|
| Rate for Payer: Healthscope Commercial |
$882.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$833.00
|
| Rate for Payer: PHP Commercial |
$833.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.00
|
| Rate for Payer: Priority Health SBD |
$617.40
|
| Rate for Payer: UMR Bronson Commercial |
$431.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.00
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$635.25
|
|
|
Service Code
|
NDC 68084-354-01
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$571.72 |
| Rate for Payer: Aetna American Axle |
$412.91
|
| Rate for Payer: Aetna Commercial |
$539.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.91
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cofinity Commercial |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$546.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.20
|
| Rate for Payer: Healthscope Commercial |
$571.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$539.96
|
| Rate for Payer: PHP Commercial |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.68
|
| Rate for Payer: Priority Health SBD |
$400.21
|
| Rate for Payer: UMR Bronson Commercial |
$279.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.44
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 0406-0552-23
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.94
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.07
|
| Rate for Payer: Priority Health SBD |
$3.66
|
| Rate for Payer: UMR Bronson Commercial |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 0406-0552-01
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.58
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.58
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.68
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.85
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UMR Bronson Commercial |
$143.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$680.75
|
|
|
Service Code
|
NDC 42858-001-10
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.53 |
| Max. Negotiated Rate |
$612.68 |
| Rate for Payer: Aetna American Axle |
$442.49
|
| Rate for Payer: Aetna Commercial |
$578.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.49
|
| Rate for Payer: Cash Price |
$544.60
|
| Rate for Payer: Cofinity Commercial |
$476.52
|
| Rate for Payer: Cofinity Commercial |
$585.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$544.60
|
| Rate for Payer: Healthscope Commercial |
$612.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$476.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$510.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$578.64
|
| Rate for Payer: PHP Commercial |
$578.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$476.52
|
| Rate for Payer: Priority Health SBD |
$428.87
|
| Rate for Payer: UMR Bronson Commercial |
$299.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$510.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$171.50
|
|
|
Service Code
|
NDC 65162-047-10
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$154.35 |
| Rate for Payer: Aetna American Axle |
$111.48
|
| Rate for Payer: Aetna Commercial |
$145.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.48
|
| Rate for Payer: Cash Price |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Cofinity Commercial |
$147.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.20
|
| Rate for Payer: Healthscope Commercial |
$154.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.78
|
| Rate for Payer: PHP Commercial |
$145.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.05
|
| Rate for Payer: Priority Health SBD |
$108.04
|
| Rate for Payer: UMR Bronson Commercial |
$75.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
NDC 57664-223-88
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna American Axle |
$154.70
|
| Rate for Payer: Aetna Commercial |
$202.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.70
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$166.60
|
| Rate for Payer: Cofinity Commercial |
$204.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.40
|
| Rate for Payer: Healthscope Commercial |
$214.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.30
|
| Rate for Payer: PHP Commercial |
$202.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
| Rate for Payer: Priority Health SBD |
$149.94
|
| Rate for Payer: UMR Bronson Commercial |
$104.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$635.25
|
|
|
Service Code
|
NDC 68084-354-11
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.51 |
| Max. Negotiated Rate |
$571.72 |
| Rate for Payer: Aetna American Axle |
$412.91
|
| Rate for Payer: Aetna Commercial |
$539.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.91
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cofinity Commercial |
$444.68
|
| Rate for Payer: Cofinity Commercial |
$546.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$508.20
|
| Rate for Payer: Healthscope Commercial |
$571.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$476.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$539.96
|
| Rate for Payer: PHP Commercial |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.68
|
| Rate for Payer: Priority Health SBD |
$400.21
|
| Rate for Payer: UMR Bronson Commercial |
$279.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$476.44
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$148.75
|
|
|
Service Code
|
NDC 10702-018-01
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$133.88 |
| Rate for Payer: Aetna American Axle |
$96.69
|
| Rate for Payer: Aetna Commercial |
$126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.69
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cofinity Commercial |
$104.12
|
| Rate for Payer: Cofinity Commercial |
$127.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.00
|
| Rate for Payer: Healthscope Commercial |
$133.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.44
|
| Rate for Payer: PHP Commercial |
$126.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.12
|
| Rate for Payer: Priority Health SBD |
$93.71
|
| Rate for Payer: UMR Bronson Commercial |
$65.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$581.00
|
|
|
Service Code
|
NDC 0406-0552-62
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.64 |
| Max. Negotiated Rate |
$522.90 |
| Rate for Payer: Aetna American Axle |
$377.65
|
| Rate for Payer: Aetna Commercial |
$493.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.65
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$406.70
|
| Rate for Payer: Cofinity Commercial |
$499.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$464.80
|
| Rate for Payer: Healthscope Commercial |
$522.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$406.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$435.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$493.85
|
| Rate for Payer: PHP Commercial |
$493.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.70
|
| Rate for Payer: Priority Health SBD |
$366.03
|
| Rate for Payer: UMR Bronson Commercial |
$255.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$435.75
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$232.05
|
|
|
Service Code
|
NDC 50268-646-15
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna American Axle |
$150.83
|
| Rate for Payer: Aetna Commercial |
$197.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.83
|
| Rate for Payer: Cash Price |
$185.64
|
| Rate for Payer: Cofinity Commercial |
$162.44
|
| Rate for Payer: Cofinity Commercial |
$199.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.64
|
| Rate for Payer: Healthscope Commercial |
$208.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.24
|
| Rate for Payer: PHP Commercial |
$197.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.44
|
| Rate for Payer: Priority Health SBD |
$146.19
|
| Rate for Payer: UMR Bronson Commercial |
$102.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.04
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$13.06
|
|
|
Service Code
|
NDC 0406-0523-23
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$11.75 |
| Rate for Payer: Aetna American Axle |
$8.49
|
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.49
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$11.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.10
|
| Rate for Payer: PHP Commercial |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.14
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.80
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$753.20
|
|
|
Service Code
|
NDC 0904-7095-61
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.41 |
| Max. Negotiated Rate |
$677.88 |
| Rate for Payer: Aetna American Axle |
$489.58
|
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.58
|
| Rate for Payer: Cash Price |
$602.56
|
| Rate for Payer: Cofinity Commercial |
$527.24
|
| Rate for Payer: Cofinity Commercial |
$647.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.56
|
| Rate for Payer: Healthscope Commercial |
$677.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$527.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$564.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$640.22
|
| Rate for Payer: PHP Commercial |
$640.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.24
|
| Rate for Payer: Priority Health SBD |
$474.52
|
| Rate for Payer: UMR Bronson Commercial |
$331.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$564.90
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$1,305.50
|
|
|
Service Code
|
NDC 0406-0523-62
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$574.42 |
| Max. Negotiated Rate |
$1,174.95 |
| Rate for Payer: Aetna American Axle |
$848.58
|
| Rate for Payer: Aetna Commercial |
$1,109.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.58
|
| Rate for Payer: Cash Price |
$1,044.40
|
| Rate for Payer: Cofinity Commercial |
$1,122.73
|
| Rate for Payer: Cofinity Commercial |
$913.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.40
|
| Rate for Payer: Healthscope Commercial |
$1,174.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$913.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$979.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,109.68
|
| Rate for Payer: PHP Commercial |
$1,109.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$913.85
|
| Rate for Payer: Priority Health SBD |
$822.46
|
| Rate for Payer: UMR Bronson Commercial |
$574.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$979.12
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$4.65
|
|
|
Service Code
|
NDC 50268-646-11
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.72
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.95
|
| Rate for Payer: PHP Commercial |
$3.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.49
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
NDC 42858-104-01
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna American Axle |
$118.30
|
| Rate for Payer: Aetna Commercial |
$154.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.30
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$127.40
|
| Rate for Payer: Cofinity Commercial |
$156.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.60
|
| Rate for Payer: Healthscope Commercial |
$163.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.70
|
| Rate for Payer: PHP Commercial |
$154.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$114.66
|
| Rate for Payer: UMR Bronson Commercial |
$80.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.50
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$327.25
|
|
|
Service Code
|
NDC 13107-046-01
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna American Axle |
$212.71
|
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.71
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cofinity Commercial |
$229.08
|
| Rate for Payer: Cofinity Commercial |
$281.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.80
|
| Rate for Payer: Healthscope Commercial |
$294.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$278.16
|
| Rate for Payer: PHP Commercial |
$278.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.08
|
| Rate for Payer: Priority Health SBD |
$206.17
|
| Rate for Payer: UMR Bronson Commercial |
$143.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.44
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 0406-0523-01
|
| Hospital Charge Code |
31864
|
|
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-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$402.50
|
|
|
Service Code
|
NDC 0904-6437-61
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna American Axle |
$261.62
|
| Rate for Payer: Aetna Commercial |
$342.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.62
|
| Rate for Payer: Cash Price |
$322.00
|
| Rate for Payer: Cofinity Commercial |
$281.75
|
| Rate for Payer: Cofinity Commercial |
$346.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.00
|
| Rate for Payer: Healthscope Commercial |
$362.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$342.12
|
| Rate for Payer: PHP Commercial |
$342.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.75
|
| Rate for Payer: Priority Health SBD |
$253.58
|
| Rate for Payer: UMR Bronson Commercial |
$177.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.88
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$360.50
|
|
|
Service Code
|
NDC 0603-4998-21
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.62 |
| Max. Negotiated Rate |
$324.45 |
| Rate for Payer: Aetna American Axle |
$234.32
|
| Rate for Payer: Aetna Commercial |
$306.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.32
|
| Rate for Payer: Cash Price |
$288.40
|
| Rate for Payer: Cofinity Commercial |
$252.35
|
| Rate for Payer: Cofinity Commercial |
$310.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.40
|
| Rate for Payer: Healthscope Commercial |
$324.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.42
|
| Rate for Payer: PHP Commercial |
$306.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.35
|
| Rate for Payer: Priority Health SBD |
$227.12
|
| Rate for Payer: UMR Bronson Commercial |
$158.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.38
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
NDC 60687-642-11
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Aetna American Axle |
$3.68
|
| Rate for Payer: Aetna Commercial |
$4.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.68
|
| Rate for Payer: Cash Price |
$4.53
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.53
|
| Rate for Payer: Healthscope Commercial |
$5.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.81
|
| Rate for Payer: PHP Commercial |
$4.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.96
|
| Rate for Payer: Priority Health SBD |
$3.57
|
| Rate for Payer: UMR Bronson Commercial |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.24
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,452.50
|
|
|
Service Code
|
NDC 0406-0512-05
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$639.10 |
| Max. Negotiated Rate |
$1,307.25 |
| Rate for Payer: Aetna American Axle |
$944.12
|
| Rate for Payer: Aetna Commercial |
$1,234.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.12
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cofinity Commercial |
$1,016.75
|
| Rate for Payer: Cofinity Commercial |
$1,249.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.00
|
| Rate for Payer: Healthscope Commercial |
$1,307.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,016.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,234.62
|
| Rate for Payer: PHP Commercial |
$1,234.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.75
|
| Rate for Payer: Priority Health SBD |
$915.08
|
| Rate for Payer: UMR Bronson Commercial |
$639.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.38
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
NDC 0406-0512-62
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna American Axle |
$45.50
|
| Rate for Payer: Aetna Commercial |
$59.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.50
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$49.00
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.00
|
| Rate for Payer: Healthscope Commercial |
$63.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.50
|
| Rate for Payer: PHP Commercial |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health SBD |
$44.10
|
| Rate for Payer: UMR Bronson Commercial |
$30.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.50
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$565.25
|
|
|
Service Code
|
NDC 60687-642-01
|
| Hospital Charge Code |
5940
|
|
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-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$290.50
|
|
|
Service Code
|
NDC 0406-0512-01
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: Cash Price |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.40
|
| Rate for Payer: Healthscope Commercial |
$261.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$246.92
|
| Rate for Payer: PHP Commercial |
$246.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.35
|
| Rate for Payer: Priority Health SBD |
$183.02
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
