|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 0406-0522-01
|
| Hospital Charge Code |
31863
|
|
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 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$11.06
|
|
|
Service Code
|
NDC 0406-0522-23
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$9.95 |
| Rate for Payer: Aetna American Axle |
$7.19
|
| Rate for Payer: Aetna Commercial |
$9.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.19
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cofinity Commercial |
$7.74
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.85
|
| Rate for Payer: Healthscope Commercial |
$9.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.40
|
| Rate for Payer: PHP Commercial |
$9.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.74
|
| Rate for Payer: Priority Health SBD |
$6.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.30
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,105.30
|
|
|
Service Code
|
NDC 0406-0522-62
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$486.33 |
| Max. Negotiated Rate |
$994.77 |
| Rate for Payer: Aetna American Axle |
$718.44
|
| Rate for Payer: Aetna Commercial |
$939.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$718.44
|
| Rate for Payer: Cash Price |
$884.24
|
| Rate for Payer: Cofinity Commercial |
$773.71
|
| Rate for Payer: Cofinity Commercial |
$950.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$884.24
|
| Rate for Payer: Healthscope Commercial |
$994.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$773.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$828.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$939.50
|
| Rate for Payer: PHP Commercial |
$939.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$773.71
|
| Rate for Payer: Priority Health SBD |
$696.34
|
| Rate for Payer: UMR Bronson Commercial |
$486.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$828.98
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$446.25
|
|
|
Service Code
|
NDC 47781-229-01
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.35 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Aetna American Axle |
$290.06
|
| Rate for Payer: Aetna Commercial |
$379.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.06
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cofinity Commercial |
$312.38
|
| Rate for Payer: Cofinity Commercial |
$383.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.00
|
| Rate for Payer: Healthscope Commercial |
$401.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$379.31
|
| Rate for Payer: PHP Commercial |
$379.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.38
|
| Rate for Payer: Priority Health SBD |
$281.14
|
| Rate for Payer: UMR Bronson Commercial |
$196.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.69
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$10.03
|
|
|
Service Code
|
NDC 50268-645-11
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$9.03 |
| Rate for Payer: Aetna American Axle |
$6.52
|
| Rate for Payer: Aetna Commercial |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.52
|
| Rate for Payer: Cash Price |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.02
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.53
|
| Rate for Payer: PHP Commercial |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.02
|
| Rate for Payer: Priority Health SBD |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$4.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.52
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$8,812.65
|
|
|
Service Code
|
NDC 63481-628-70
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,877.57 |
| Max. Negotiated Rate |
$7,931.38 |
| Rate for Payer: Aetna American Axle |
$5,728.22
|
| Rate for Payer: Aetna Commercial |
$7,490.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,728.22
|
| Rate for Payer: Cash Price |
$7,050.12
|
| Rate for Payer: Cofinity Commercial |
$6,168.86
|
| Rate for Payer: Cofinity Commercial |
$7,578.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,050.12
|
| Rate for Payer: Healthscope Commercial |
$7,931.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,168.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,609.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7,490.75
|
| Rate for Payer: PHP Commercial |
$7,490.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,168.86
|
| Rate for Payer: Priority Health SBD |
$5,551.97
|
| Rate for Payer: UMR Bronson Commercial |
$3,877.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,609.49
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
NDC 0904-6438-61
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna American Axle |
$309.40
|
| Rate for Payer: Aetna Commercial |
$404.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cofinity Commercial |
$333.20
|
| Rate for Payer: Cofinity Commercial |
$409.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.80
|
| Rate for Payer: Healthscope Commercial |
$428.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$404.60
|
| Rate for Payer: PHP Commercial |
$404.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.20
|
| Rate for Payer: Priority Health SBD |
$299.88
|
| Rate for Payer: UMR Bronson Commercial |
$209.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.00
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$877.11
|
|
|
Service Code
|
NDC 0093-5731-01
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.93 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna American Axle |
$570.12
|
| Rate for Payer: Aetna Commercial |
$745.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.12
|
| Rate for Payer: Cash Price |
$701.69
|
| Rate for Payer: Cofinity Commercial |
$613.98
|
| Rate for Payer: Cofinity Commercial |
$754.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.69
|
| Rate for Payer: Healthscope Commercial |
$789.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$745.54
|
| Rate for Payer: PHP Commercial |
$745.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.98
|
| Rate for Payer: Priority Health SBD |
$552.58
|
| Rate for Payer: UMR Bronson Commercial |
$385.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.83
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$298.74
|
|
|
Service Code
|
NDC 59011-410-20
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.45 |
| Max. Negotiated Rate |
$268.87 |
| Rate for Payer: Aetna American Axle |
$194.18
|
| Rate for Payer: Aetna Commercial |
$253.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.18
|
| Rate for Payer: Cash Price |
$238.99
|
| Rate for Payer: Cofinity Commercial |
$209.12
|
| Rate for Payer: Cofinity Commercial |
$256.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.99
|
| Rate for Payer: Healthscope Commercial |
$268.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.93
|
| Rate for Payer: PHP Commercial |
$253.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.12
|
| Rate for Payer: Priority Health SBD |
$188.21
|
| Rate for Payer: UMR Bronson Commercial |
$131.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.06
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$2,141.88
|
|
|
Service Code
|
NDC 59011-415-10
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$942.43 |
| Max. Negotiated Rate |
$1,927.69 |
| Rate for Payer: Aetna American Axle |
$1,392.22
|
| Rate for Payer: Aetna Commercial |
$1,820.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,392.22
|
| Rate for Payer: Cash Price |
$1,713.50
|
| Rate for Payer: Cofinity Commercial |
$1,499.32
|
| Rate for Payer: Cofinity Commercial |
$1,842.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,713.50
|
| Rate for Payer: Healthscope Commercial |
$1,927.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,499.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,606.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,820.60
|
| Rate for Payer: PHP Commercial |
$1,820.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,499.32
|
| Rate for Payer: Priority Health SBD |
$1,349.38
|
| Rate for Payer: UMR Bronson Commercial |
$942.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,606.41
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$439.46
|
|
|
Service Code
|
NDC 59011-415-20
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$395.51 |
| Rate for Payer: Aetna American Axle |
$285.65
|
| Rate for Payer: Aetna Commercial |
$373.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.65
|
| Rate for Payer: Cash Price |
$351.57
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.57
|
| Rate for Payer: Healthscope Commercial |
$395.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.54
|
| Rate for Payer: PHP Commercial |
$373.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.62
|
| Rate for Payer: Priority Health SBD |
$276.86
|
| Rate for Payer: UMR Bronson Commercial |
$193.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.60
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$470.98
|
|
|
Service Code
|
NDC 59011-420-20
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.23 |
| Max. Negotiated Rate |
$423.88 |
| Rate for Payer: Aetna American Axle |
$306.14
|
| Rate for Payer: Aetna Commercial |
$400.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.14
|
| Rate for Payer: Cash Price |
$376.78
|
| Rate for Payer: Cofinity Commercial |
$329.69
|
| Rate for Payer: Cofinity Commercial |
$405.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.78
|
| Rate for Payer: Healthscope Commercial |
$423.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$400.33
|
| Rate for Payer: PHP Commercial |
$400.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.69
|
| Rate for Payer: Priority Health SBD |
$296.72
|
| Rate for Payer: UMR Bronson Commercial |
$207.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.24
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$806.26
|
|
|
Service Code
|
NDC 59011-440-20
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.75 |
| Max. Negotiated Rate |
$725.63 |
| Rate for Payer: Aetna American Axle |
$524.07
|
| Rate for Payer: Aetna Commercial |
$685.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.07
|
| Rate for Payer: Cash Price |
$645.01
|
| Rate for Payer: Cofinity Commercial |
$564.38
|
| Rate for Payer: Cofinity Commercial |
$693.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$645.01
|
| Rate for Payer: Healthscope Commercial |
$725.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$564.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$604.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$685.32
|
| Rate for Payer: PHP Commercial |
$685.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.38
|
| Rate for Payer: Priority Health SBD |
$507.94
|
| Rate for Payer: UMR Bronson Commercial |
$354.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$604.70
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$3,931.95
|
|
|
Service Code
|
NDC 59011-440-10
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,730.06 |
| Max. Negotiated Rate |
$3,538.76 |
| Rate for Payer: Aetna American Axle |
$2,555.77
|
| Rate for Payer: Aetna Commercial |
$3,342.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,555.77
|
| Rate for Payer: Cash Price |
$3,145.56
|
| Rate for Payer: Cofinity Commercial |
$2,752.36
|
| Rate for Payer: Cofinity Commercial |
$3,381.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,145.56
|
| Rate for Payer: Healthscope Commercial |
$3,538.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,752.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,948.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,342.16
|
| Rate for Payer: PHP Commercial |
$3,342.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,752.36
|
| Rate for Payer: Priority Health SBD |
$2,477.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,730.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,948.96
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$4,136.88
|
|
|
Service Code
|
NDC 0093-5734-01
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,820.23 |
| Max. Negotiated Rate |
$3,723.19 |
| Rate for Payer: Aetna American Axle |
$2,688.97
|
| Rate for Payer: Aetna Commercial |
$3,516.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.97
|
| Rate for Payer: Cash Price |
$3,309.50
|
| Rate for Payer: Cofinity Commercial |
$2,895.82
|
| Rate for Payer: Cofinity Commercial |
$3,557.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,309.50
|
| Rate for Payer: Healthscope Commercial |
$3,723.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,895.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,102.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,516.35
|
| Rate for Payer: PHP Commercial |
$3,516.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,895.82
|
| Rate for Payer: Priority Health SBD |
$2,606.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,820.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,102.66
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,407.52
|
|
|
Service Code
|
NDC 59011-480-20
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$619.31 |
| Max. Negotiated Rate |
$1,266.77 |
| Rate for Payer: Aetna American Axle |
$914.89
|
| Rate for Payer: Aetna Commercial |
$1,196.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$914.89
|
| Rate for Payer: Cash Price |
$1,126.02
|
| Rate for Payer: Cofinity Commercial |
$1,210.47
|
| Rate for Payer: Cofinity Commercial |
$985.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,126.02
|
| Rate for Payer: Healthscope Commercial |
$1,266.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$985.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,055.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,196.39
|
| Rate for Payer: PHP Commercial |
$1,196.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.26
|
| Rate for Payer: Priority Health SBD |
$886.74
|
| Rate for Payer: UMR Bronson Commercial |
$619.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,055.64
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$6,861.36
|
|
|
Service Code
|
NDC 59011-480-10
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,019.00 |
| Max. Negotiated Rate |
$6,175.22 |
| Rate for Payer: Aetna American Axle |
$4,459.88
|
| Rate for Payer: Aetna Commercial |
$5,832.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,459.88
|
| Rate for Payer: Cash Price |
$5,489.09
|
| Rate for Payer: Cofinity Commercial |
$4,802.95
|
| Rate for Payer: Cofinity Commercial |
$5,900.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,489.09
|
| Rate for Payer: Healthscope Commercial |
$6,175.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,802.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,146.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,832.16
|
| Rate for Payer: PHP Commercial |
$5,832.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,802.95
|
| Rate for Payer: Priority Health SBD |
$4,322.66
|
| Rate for Payer: UMR Bronson Commercial |
$3,019.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,146.02
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
NDC 2390002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna American Axle |
$21.12
|
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.62
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health SBD |
$20.48
|
| Rate for Payer: UMR Bronson Commercial |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$26.88
|
|
|
Service Code
|
NDC 4110001511
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna American Axle |
$17.47
|
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.47
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.85
|
| Rate for Payer: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.82
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.16
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
NDC 4110081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.00
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 2390001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 59390-036-13
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.58
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.60
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 70000-0001-1
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$11.34
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.77
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.34
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 45802-410-59
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.26
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMORPHONE 10 MG TABLET
|
Facility
|
IP
|
$758.88
|
|
|
Service Code
|
NDC 31722-930-01
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$645.05
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.22
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$333.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
