|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Advantage |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.07
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 23155081001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$117.50
|
|
|
Service Code
|
NDC 52817026010
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna American Axle |
$76.38
|
| Rate for Payer: Aetna Commercial |
$99.88
|
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.38
|
| Rate for Payer: BCBS Complete |
$47.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cofinity Advantage |
$82.25
|
| Rate for Payer: Cofinity Commercial |
$101.05
|
| 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: MI Amish Medical Board Commercial |
$94.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.12
|
| Rate for Payer: PHP Commercial |
$99.88
|
| Rate for Payer: Priority Health SBD |
$74.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.38
|
| Rate for Payer: UHC Core |
$61.22
|
| Rate for Payer: UHC Exchange |
$46.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00832003800
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Advantage |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$141.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$192.70
|
|
|
Service Code
|
NDC 10702020101
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna Medicare |
$96.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: BCBS Complete |
$77.08
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.25
|
| Rate for Payer: UHC Core |
$100.40
|
| Rate for Payer: UHC Exchange |
$75.73
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$192.70
|
|
|
Service Code
|
NDC 10702020101
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.79 |
| Max. Negotiated Rate |
$173.43 |
| Rate for Payer: Aetna American Axle |
$125.25
|
| Rate for Payer: Aetna Commercial |
$163.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.25
|
| Rate for Payer: Cash Price |
$154.16
|
| Rate for Payer: Cofinity Advantage |
$134.89
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.16
|
| Rate for Payer: Healthscope Commercial |
$173.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.53
|
| Rate for Payer: PHP Commercial |
$163.79
|
| Rate for Payer: Priority Health SBD |
$121.40
|
| Rate for Payer: UMR Bronson Commercial |
$84.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.53
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 23155081001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$495.80
|
|
|
Service Code
|
NDC 50268062815
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.45 |
| Max. Negotiated Rate |
$446.22 |
| Rate for Payer: Aetna American Axle |
$322.27
|
| Rate for Payer: Aetna Commercial |
$421.43
|
| Rate for Payer: Aetna Medicare |
$247.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.27
|
| Rate for Payer: BCBS Complete |
$198.32
|
| Rate for Payer: Cash Price |
$396.64
|
| Rate for Payer: Cofinity Advantage |
$347.06
|
| Rate for Payer: Cofinity Commercial |
$426.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.64
|
| Rate for Payer: Healthscope Commercial |
$446.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.85
|
| Rate for Payer: PHP Commercial |
$421.43
|
| Rate for Payer: Priority Health SBD |
$312.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.27
|
| Rate for Payer: UHC Core |
$258.31
|
| Rate for Payer: UHC Exchange |
$194.85
|
| Rate for Payer: UMR Bronson Commercial |
$183.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.85
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$265.07
|
|
|
Service Code
|
NDC 68084061021
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.08 |
| Max. Negotiated Rate |
$238.56 |
| Rate for Payer: Aetna American Axle |
$172.30
|
| Rate for Payer: Aetna Commercial |
$225.31
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.30
|
| Rate for Payer: BCBS Complete |
$106.03
|
| Rate for Payer: Cash Price |
$212.06
|
| Rate for Payer: Cofinity Advantage |
$185.55
|
| Rate for Payer: Cofinity Commercial |
$227.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.06
|
| Rate for Payer: Healthscope Commercial |
$238.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.80
|
| Rate for Payer: PHP Commercial |
$225.31
|
| Rate for Payer: Priority Health SBD |
$166.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.30
|
| Rate for Payer: UHC Core |
$138.10
|
| Rate for Payer: UHC Exchange |
$104.17
|
| Rate for Payer: UMR Bronson Commercial |
$98.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.80
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$495.80
|
|
|
Service Code
|
NDC 50268062815
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.15 |
| Max. Negotiated Rate |
$446.22 |
| Rate for Payer: Aetna American Axle |
$322.27
|
| Rate for Payer: Aetna Commercial |
$421.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.27
|
| Rate for Payer: Cash Price |
$396.64
|
| Rate for Payer: Cofinity Advantage |
$347.06
|
| Rate for Payer: Cofinity Commercial |
$426.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.64
|
| Rate for Payer: Healthscope Commercial |
$446.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.85
|
| Rate for Payer: PHP Commercial |
$421.43
|
| Rate for Payer: Priority Health SBD |
$312.35
|
| Rate for Payer: UMR Bronson Commercial |
$218.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.85
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$9.92
|
|
|
Service Code
|
NDC 50268062811
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna American Axle |
$6.45
|
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.45
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cofinity Advantage |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$8.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.44
|
| Rate for Payer: PHP Commercial |
$8.43
|
| Rate for Payer: Priority Health SBD |
$6.25
|
| Rate for Payer: UMR Bronson Commercial |
$4.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.44
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
NDC 50268062811
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna American Axle |
$6.45
|
| Rate for Payer: Aetna Commercial |
$8.43
|
| Rate for Payer: Aetna Medicare |
$4.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.45
|
| Rate for Payer: BCBS Complete |
$3.97
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Cofinity Advantage |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.94
|
| Rate for Payer: Healthscope Commercial |
$8.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.44
|
| Rate for Payer: PHP Commercial |
$8.43
|
| Rate for Payer: Priority Health SBD |
$6.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.45
|
| Rate for Payer: UHC Core |
$5.17
|
| Rate for Payer: UHC Exchange |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$3.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.44
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.84
|
|
|
Service Code
|
NDC 68084061011
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cofinity Advantage |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$7.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.07
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.63
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: Priority Health SBD |
$5.57
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.63
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.84
|
|
|
Service Code
|
NDC 68084061011
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: Cash Price |
$7.07
|
| Rate for Payer: Cofinity Advantage |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$7.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.07
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.63
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: Priority Health SBD |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.75
|
| Rate for Payer: UHC Core |
$4.61
|
| Rate for Payer: UHC Exchange |
$3.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.63
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$265.07
|
|
|
Service Code
|
NDC 68084061021
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.63 |
| Max. Negotiated Rate |
$238.56 |
| Rate for Payer: Aetna American Axle |
$172.30
|
| Rate for Payer: Aetna Commercial |
$225.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.30
|
| Rate for Payer: Cash Price |
$212.06
|
| Rate for Payer: Cofinity Advantage |
$185.55
|
| Rate for Payer: Cofinity Commercial |
$227.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.06
|
| Rate for Payer: Healthscope Commercial |
$238.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.80
|
| Rate for Payer: PHP Commercial |
$225.31
|
| Rate for Payer: Priority Health SBD |
$166.99
|
| Rate for Payer: UMR Bronson Commercial |
$116.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.80
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$679.68
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna American Axle |
$441.79
|
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: Aetna Medicare |
$339.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.79
|
| Rate for Payer: BCBS Complete |
$271.87
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Advantage |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health SBD |
$428.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.79
|
| Rate for Payer: UHC Core |
$354.11
|
| Rate for Payer: UHC Exchange |
$267.11
|
| Rate for Payer: UMR Bronson Commercial |
$251.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 65162037110
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.56 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.60
|
| Rate for Payer: UHC Core |
$182.43
|
| Rate for Payer: UHC Exchange |
$137.61
|
| Rate for Payer: UMR Bronson Commercial |
$129.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$679.68
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.06 |
| Max. Negotiated Rate |
$611.71 |
| Rate for Payer: Aetna American Axle |
$441.79
|
| Rate for Payer: Aetna Commercial |
$577.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.79
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Advantage |
$475.78
|
| Rate for Payer: Cofinity Commercial |
$584.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$611.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$475.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$509.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: PHP Commercial |
$577.73
|
| Rate for Payer: Priority Health SBD |
$428.20
|
| Rate for Payer: UMR Bronson Commercial |
$299.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$509.76
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 65162037110
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$315.13 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Advantage |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$262.61
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$154.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
NDC 00406851501
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.66 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna American Axle |
$336.70
|
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna Medicare |
$259.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.70
|
| Rate for Payer: BCBS Complete |
$207.20
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$414.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.50
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: Priority Health SBD |
$326.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.70
|
| Rate for Payer: UHC Core |
$269.88
|
| Rate for Payer: UHC Exchange |
$203.57
|
| Rate for Payer: UMR Bronson Commercial |
$191.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.50
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$705.25
|
|
|
Service Code
|
NDC 47781026401
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.94 |
| Max. Negotiated Rate |
$634.73 |
| Rate for Payer: Aetna American Axle |
$458.41
|
| Rate for Payer: Aetna Commercial |
$599.46
|
| Rate for Payer: Aetna Medicare |
$352.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.41
|
| Rate for Payer: BCBS Complete |
$282.10
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cofinity Advantage |
$493.68
|
| Rate for Payer: Cofinity Commercial |
$606.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.20
|
| Rate for Payer: Healthscope Commercial |
$634.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$564.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$528.94
|
| Rate for Payer: PHP Commercial |
$599.46
|
| Rate for Payer: Priority Health SBD |
$444.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.41
|
| Rate for Payer: UHC Core |
$367.44
|
| Rate for Payer: UHC Exchange |
$277.16
|
| Rate for Payer: UMR Bronson Commercial |
$260.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.94
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$388.50
|
|
|
Service Code
|
NDC 65162004910
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna American Axle |
$252.53
|
| Rate for Payer: Aetna Commercial |
$330.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.53
|
| Rate for Payer: Cash Price |
$310.80
|
| Rate for Payer: Cofinity Advantage |
$271.95
|
| Rate for Payer: Cofinity Commercial |
$334.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.80
|
| Rate for Payer: Healthscope Commercial |
$349.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.38
|
| Rate for Payer: PHP Commercial |
$330.23
|
| Rate for Payer: Priority Health SBD |
$244.75
|
| Rate for Payer: UMR Bronson Commercial |
$170.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.38
|
|
