|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$705.25
|
|
|
Service Code
|
NDC 47781026401
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$634.73 |
| 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 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: 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: UMR Bronson Commercial |
$310.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.94
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
NDC 00406851501
|
| 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 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: 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: 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 57664018788
|
| 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 |
$288.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$288.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.62
|
| Rate for Payer: PHP Commercial |
$288.57
|
| 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
|
$421.75
|
|
|
Service Code
|
NDC 42858000301
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.57 |
| Max. Negotiated Rate |
$379.57 |
| Rate for Payer: Aetna American Axle |
$274.14
|
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.14
|
| Rate for Payer: Cash Price |
$337.40
|
| Rate for Payer: Cofinity Advantage |
$295.23
|
| Rate for Payer: Cofinity Commercial |
$362.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.40
|
| Rate for Payer: Healthscope Commercial |
$379.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.31
|
| Rate for Payer: PHP Commercial |
$358.49
|
| Rate for Payer: Priority Health SBD |
$265.70
|
| Rate for Payer: UMR Bronson Commercial |
$185.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.31
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$388.50
|
|
|
Service Code
|
NDC 65162004910
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.75 |
| Max. Negotiated Rate |
$349.65 |
| Rate for Payer: Aetna American Axle |
$252.53
|
| Rate for Payer: Aetna Commercial |
$330.23
|
| Rate for Payer: Aetna Medicare |
$194.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.53
|
| Rate for Payer: BCBS Complete |
$155.40
|
| 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: MI Amish Medical Board Commercial |
$310.80
|
| 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: UHC All Payor (Choice/PPO) |
$252.53
|
| Rate for Payer: UHC Core |
$202.41
|
| Rate for Payer: UHC Exchange |
$152.68
|
| Rate for Payer: UMR Bronson Commercial |
$143.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.38
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$339.50
|
|
|
Service Code
|
NDC 57664018788
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Aetna American Axle |
$220.68
|
| Rate for Payer: Aetna Commercial |
$288.57
|
| Rate for Payer: Aetna Medicare |
$169.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: BCBS Complete |
$135.80
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$271.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.62
|
| Rate for Payer: PHP Commercial |
$288.57
|
| Rate for Payer: Priority Health SBD |
$213.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.68
|
| Rate for Payer: UHC Core |
$176.88
|
| Rate for Payer: UHC Exchange |
$133.42
|
| Rate for Payer: UMR Bronson Commercial |
$125.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.62
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$421.75
|
|
|
Service Code
|
NDC 42858000301
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.05 |
| Max. Negotiated Rate |
$379.57 |
| Rate for Payer: Aetna American Axle |
$274.14
|
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Medicare |
$210.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.14
|
| Rate for Payer: BCBS Complete |
$168.70
|
| Rate for Payer: Cash Price |
$337.40
|
| Rate for Payer: Cofinity Advantage |
$295.23
|
| Rate for Payer: Cofinity Commercial |
$362.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.40
|
| Rate for Payer: Healthscope Commercial |
$379.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$295.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$337.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.31
|
| Rate for Payer: PHP Commercial |
$358.49
|
| Rate for Payer: Priority Health SBD |
$265.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.14
|
| Rate for Payer: UHC Core |
$219.73
|
| Rate for Payer: UHC Exchange |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$156.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.31
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 00406853001
|
| 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 Advantage |
$562.27
|
| Rate for Payer: Cofinity Commercial |
$690.79
|
| 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 |
$562.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.44
|
| Rate for Payer: PHP Commercial |
$682.76
|
| 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 30 MG TABLET
|
Facility
|
IP
|
$743.75
|
|
|
Service Code
|
NDC 65162005110
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.25 |
| Max. Negotiated Rate |
$669.38 |
| Rate for Payer: Aetna American Axle |
$483.44
|
| Rate for Payer: Aetna Commercial |
$632.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.44
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cofinity Advantage |
$520.62
|
| Rate for Payer: Cofinity Commercial |
$639.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.00
|
| Rate for Payer: Healthscope Commercial |
$669.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.81
|
| Rate for Payer: PHP Commercial |
$632.19
|
| Rate for Payer: Priority Health SBD |
$468.56
|
| Rate for Payer: UMR Bronson Commercial |
$327.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
NDC 47781026501
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$415.80 |
| Rate for Payer: Aetna American Axle |
$300.30
|
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna Medicare |
$231.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: BCBS Complete |
$184.80
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$369.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: Priority Health SBD |
$291.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.30
|
| Rate for Payer: UHC Core |
$240.70
|
| Rate for Payer: UHC Exchange |
$181.57
|
| Rate for Payer: UMR Bronson Commercial |
$170.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.50
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$631.75
|
|
|
Service Code
|
NDC 57664022488
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$568.58 |
| Rate for Payer: Aetna American Axle |
$410.64
|
| Rate for Payer: Aetna Commercial |
$536.99
|
| Rate for Payer: Aetna Medicare |
$315.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.64
|
| Rate for Payer: BCBS Complete |
$252.70
|
| Rate for Payer: Cash Price |
$505.40
|
| Rate for Payer: Cofinity Advantage |
$442.23
|
| 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 |
$442.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$505.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.81
|
| Rate for Payer: PHP Commercial |
$536.99
|
| Rate for Payer: Priority Health SBD |
$398.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.64
|
| Rate for Payer: UHC Core |
$329.14
|
| Rate for Payer: UHC Exchange |
$248.28
|
| Rate for Payer: UMR Bronson Commercial |
$233.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$743.75
|
|
|
Service Code
|
NDC 65162005110
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.19 |
| Max. Negotiated Rate |
$669.38 |
| Rate for Payer: Aetna American Axle |
$483.44
|
| Rate for Payer: Aetna Commercial |
$632.19
|
| Rate for Payer: Aetna Medicare |
$371.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.44
|
| Rate for Payer: BCBS Complete |
$297.50
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cofinity Advantage |
$520.62
|
| Rate for Payer: Cofinity Commercial |
$639.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.00
|
| Rate for Payer: Healthscope Commercial |
$669.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$520.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$557.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$632.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$557.81
|
| Rate for Payer: PHP Commercial |
$632.19
|
| Rate for Payer: Priority Health SBD |
$468.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.44
|
| Rate for Payer: UHC Core |
$387.49
|
| Rate for Payer: UHC Exchange |
$292.29
|
| Rate for Payer: UMR Bronson Commercial |
$275.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$557.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$799.75
|
|
|
Service Code
|
NDC 42806000801
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.91 |
| Max. Negotiated Rate |
$719.77 |
| Rate for Payer: Aetna American Axle |
$519.84
|
| Rate for Payer: Aetna Commercial |
$679.79
|
| Rate for Payer: Aetna Medicare |
$399.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.84
|
| Rate for Payer: BCBS Complete |
$319.90
|
| Rate for Payer: Cash Price |
$639.80
|
| Rate for Payer: Cofinity Advantage |
$559.83
|
| Rate for Payer: Cofinity Commercial |
$687.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.80
|
| Rate for Payer: Healthscope Commercial |
$719.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$639.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$679.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.81
|
| Rate for Payer: PHP Commercial |
$679.79
|
| Rate for Payer: Priority Health SBD |
$503.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.84
|
| Rate for Payer: UHC Core |
$416.67
|
| Rate for Payer: UHC Exchange |
$314.30
|
| Rate for Payer: UMR Bronson Commercial |
$295.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$599.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$803.25
|
|
|
Service Code
|
NDC 10702000901
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna Medicare |
$401.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: BCBS Complete |
$321.30
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cofinity Advantage |
$562.27
|
| Rate for Payer: Cofinity Commercial |
$690.79
|
| 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 |
$562.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.44
|
| Rate for Payer: PHP Commercial |
$682.76
|
| Rate for Payer: Priority Health SBD |
$506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.11
|
| Rate for Payer: UHC Core |
$418.49
|
| Rate for Payer: UHC Exchange |
$315.68
|
| Rate for Payer: UMR Bronson Commercial |
$297.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.44
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$631.75
|
|
|
Service Code
|
NDC 57664022488
|
| 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 Advantage |
$442.23
|
| 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 |
$442.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$473.81
|
| Rate for Payer: PHP Commercial |
$536.99
|
| 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
|
$799.75
|
|
|
Service Code
|
NDC 42806000801
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.89 |
| Max. Negotiated Rate |
$719.77 |
| 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 Advantage |
$559.83
|
| Rate for Payer: Cofinity Commercial |
$687.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$639.80
|
| Rate for Payer: Healthscope Commercial |
$719.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$559.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$599.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$679.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$599.81
|
| Rate for Payer: PHP Commercial |
$679.79
|
| 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
|
OP
|
$803.25
|
|
|
Service Code
|
NDC 00406853001
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna Medicare |
$401.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: BCBS Complete |
$321.30
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cofinity Advantage |
$562.27
|
| Rate for Payer: Cofinity Commercial |
$690.79
|
| 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 |
$562.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.44
|
| Rate for Payer: PHP Commercial |
$682.76
|
| Rate for Payer: Priority Health SBD |
$506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.11
|
| Rate for Payer: UHC Core |
$418.49
|
| Rate for Payer: UHC Exchange |
$315.68
|
| Rate for Payer: UMR Bronson Commercial |
$297.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.44
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$462.00
|
|
|
Service Code
|
NDC 47781026501
|
| 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 Advantage |
$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 Commercial |
$392.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PHP Commercial |
$392.70
|
| 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
|
$803.25
|
|
|
Service Code
|
NDC 10702000901
|
| 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 Advantage |
$562.27
|
| Rate for Payer: Cofinity Commercial |
$690.79
|
| 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 |
$562.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.44
|
| Rate for Payer: PHP Commercial |
$682.76
|
| 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
|
OP
|
$25.97
|
|
|
Service Code
|
NDC 00904682805
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna American Axle |
$16.88
|
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: BCBS Complete |
$10.39
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Exchange |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.48
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$23.87
|
|
|
Service Code
|
NDC 00904682894
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna American Axle |
$15.52
|
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cofinity Advantage |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.90
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: Priority Health SBD |
$15.04
|
| Rate for Payer: UMR Bronson Commercial |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$34.86
|
|
|
Service Code
|
NDC 00121482705
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna American Axle |
$22.66
|
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.66
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Advantage |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: Priority Health SBD |
$21.96
|
| Rate for Payer: UMR Bronson Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$34.86
|
|
|
Service Code
|
NDC 00121482705
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$31.37 |
| Rate for Payer: Aetna American Axle |
$22.66
|
| Rate for Payer: Aetna Commercial |
$29.63
|
| Rate for Payer: Aetna Medicare |
$17.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.66
|
| Rate for Payer: BCBS Complete |
$13.94
|
| Rate for Payer: Cash Price |
$27.89
|
| Rate for Payer: Cofinity Advantage |
$24.40
|
| Rate for Payer: Cofinity Commercial |
$29.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.89
|
| Rate for Payer: Healthscope Commercial |
$31.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.14
|
| Rate for Payer: PHP Commercial |
$29.63
|
| Rate for Payer: Priority Health SBD |
$21.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.66
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Exchange |
$13.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.14
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$25.97
|
|
|
Service Code
|
NDC 00904682805
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna American Axle |
$16.88
|
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$11.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.48
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
NDC 60687040640
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna American Axle |
$18.56
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Advantage |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.42
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
