|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$34.86
|
|
|
Service Code
|
NDC 00121482740
|
| 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
|
$23.87
|
|
|
Service Code
|
NDC 00904682894
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna American Axle |
$15.52
|
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Medicare |
$11.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: BCBS Complete |
$9.55
|
| 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: MI Amish Medical Board Commercial |
$19.10
|
| 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: UHC All Payor (Choice/PPO) |
$15.52
|
| Rate for Payer: UHC Core |
$12.44
|
| Rate for Payer: UHC Exchange |
$9.38
|
| Rate for Payer: UMR Bronson Commercial |
$8.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
NDC 60687040640
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna American Axle |
$18.56
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: BCBS Complete |
$11.42
|
| 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: MI Amish Medical Board Commercial |
$22.85
|
| 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: UHC All Payor (Choice/PPO) |
$18.56
|
| Rate for Payer: UHC Core |
$14.88
|
| Rate for Payer: UHC Exchange |
$11.22
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$21.70
|
|
|
Service Code
|
NDC 60687040677
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna American Axle |
$14.11
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.11
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: Cofinity Advantage |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$18.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.36
|
| Rate for Payer: Healthscope Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.27
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: Priority Health SBD |
$13.67
|
| Rate for Payer: UMR Bronson Commercial |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.27
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$34.86
|
|
|
Service Code
|
NDC 00121482740
|
| 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
|
OP
|
$647.50
|
|
|
Service Code
|
NDC 00904667840
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.57 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna American Axle |
$420.88
|
| Rate for Payer: Aetna Commercial |
$550.38
|
| Rate for Payer: Aetna Medicare |
$323.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.88
|
| Rate for Payer: BCBS Complete |
$259.00
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: Cofinity Advantage |
$453.25
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.00
|
| Rate for Payer: Healthscope Commercial |
$582.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$518.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.62
|
| Rate for Payer: PHP Commercial |
$550.38
|
| Rate for Payer: Priority Health SBD |
$407.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.88
|
| Rate for Payer: UHC Core |
$337.35
|
| Rate for Payer: UHC Exchange |
$254.47
|
| Rate for Payer: UMR Bronson Commercial |
$239.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.62
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$647.50
|
|
|
Service Code
|
NDC 00904667840
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna American Axle |
$420.88
|
| Rate for Payer: Aetna Commercial |
$550.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.88
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: Cofinity Advantage |
$453.25
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.00
|
| Rate for Payer: Healthscope Commercial |
$582.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$485.62
|
| Rate for Payer: PHP Commercial |
$550.38
|
| Rate for Payer: Priority Health SBD |
$407.93
|
| Rate for Payer: UMR Bronson Commercial |
$284.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.62
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$21.70
|
|
|
Service Code
|
NDC 60687040677
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.03 |
| Max. Negotiated Rate |
$19.53 |
| Rate for Payer: Aetna American Axle |
$14.11
|
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$10.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.11
|
| Rate for Payer: BCBS Complete |
$8.68
|
| Rate for Payer: Cash Price |
$17.36
|
| Rate for Payer: Cofinity Advantage |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$18.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.36
|
| Rate for Payer: Healthscope Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.27
|
| Rate for Payer: PHP Commercial |
$18.45
|
| Rate for Payer: Priority Health SBD |
$13.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.11
|
| Rate for Payer: UHC Core |
$11.31
|
| Rate for Payer: UHC Exchange |
$8.53
|
| Rate for Payer: UMR Bronson Commercial |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.27
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$610.75
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.98 |
| Max. Negotiated Rate |
$549.67 |
| Rate for Payer: Aetna American Axle |
$396.99
|
| Rate for Payer: Aetna Commercial |
$519.14
|
| Rate for Payer: Aetna Medicare |
$305.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.99
|
| Rate for Payer: BCBS Complete |
$244.30
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: Cofinity Advantage |
$427.52
|
| Rate for Payer: Cofinity Commercial |
$525.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.60
|
| Rate for Payer: Healthscope Commercial |
$549.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$488.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.06
|
| Rate for Payer: PHP Commercial |
$519.14
|
| Rate for Payer: Priority Health SBD |
$384.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.99
|
| Rate for Payer: UHC Core |
$318.20
|
| Rate for Payer: UHC Exchange |
$240.02
|
| Rate for Payer: UMR Bronson Commercial |
$225.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.06
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
NDC 57664022388
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.06 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna American Axle |
$154.70
|
| Rate for Payer: Aetna Commercial |
$202.30
|
| Rate for Payer: Aetna Medicare |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.70
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Advantage |
$166.60
|
| Rate for Payer: Cofinity Commercial |
$204.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.40
|
| Rate for Payer: Healthscope Commercial |
$214.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.50
|
| Rate for Payer: PHP Commercial |
$202.30
|
| Rate for Payer: Priority Health SBD |
$149.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.70
|
| Rate for Payer: UHC Core |
$124.00
|
| Rate for Payer: UHC Exchange |
$93.53
|
| Rate for Payer: UMR Bronson Commercial |
$88.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$7.93
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna American Axle |
$5.15
|
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.55
|
| Rate for Payer: Cofinity Commercial |
$6.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.95
|
| Rate for Payer: PHP Commercial |
$6.74
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.95
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna American Axle |
$147.88
|
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.88
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cofinity Advantage |
$159.25
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.00
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UMR Bronson Commercial |
$100.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$733.25
|
|
|
Service Code
|
NDC 42858000110
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.30 |
| Max. Negotiated Rate |
$659.92 |
| Rate for Payer: Aetna American Axle |
$476.61
|
| Rate for Payer: Aetna Commercial |
$623.26
|
| Rate for Payer: Aetna Medicare |
$366.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.61
|
| Rate for Payer: BCBS Complete |
$293.30
|
| Rate for Payer: Cash Price |
$586.60
|
| Rate for Payer: Cofinity Advantage |
$513.27
|
| Rate for Payer: Cofinity Commercial |
$630.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$586.60
|
| Rate for Payer: Healthscope Commercial |
$659.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$513.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$549.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$586.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.94
|
| Rate for Payer: PHP Commercial |
$623.26
|
| Rate for Payer: Priority Health SBD |
$461.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.61
|
| Rate for Payer: UHC Core |
$382.02
|
| Rate for Payer: UHC Exchange |
$288.17
|
| Rate for Payer: UMR Bronson Commercial |
$271.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.94
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$208.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$187.43 |
| Rate for Payer: Aetna American Axle |
$135.36
|
| Rate for Payer: Aetna Commercial |
$177.01
|
| Rate for Payer: Aetna Medicare |
$104.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.36
|
| Rate for Payer: BCBS Complete |
$83.30
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cofinity Advantage |
$145.78
|
| Rate for Payer: Cofinity Commercial |
$179.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.60
|
| Rate for Payer: Healthscope Commercial |
$187.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.19
|
| Rate for Payer: PHP Commercial |
$177.01
|
| Rate for Payer: Priority Health SBD |
$131.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.36
|
| Rate for Payer: UHC Core |
$108.50
|
| Rate for Payer: UHC Exchange |
$81.84
|
| Rate for Payer: UMR Bronson Commercial |
$77.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.19
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Advantage |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$189.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PHP Commercial |
$178.50
|
| Rate for Payer: Priority Health SBD |
$132.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.50
|
| Rate for Payer: UHC Core |
$109.41
|
| Rate for Payer: UHC Exchange |
$82.53
|
| Rate for Payer: UMR Bronson Commercial |
$77.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$918.75
|
|
|
Service Code
|
NDC 47781026305
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.94 |
| Max. Negotiated Rate |
$826.88 |
| Rate for Payer: Aetna American Axle |
$597.19
|
| Rate for Payer: Aetna Commercial |
$780.94
|
| Rate for Payer: Aetna Medicare |
$459.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.19
|
| Rate for Payer: BCBS Complete |
$367.50
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cofinity Advantage |
$643.12
|
| Rate for Payer: Cofinity Commercial |
$790.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.00
|
| Rate for Payer: Healthscope Commercial |
$826.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$643.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$735.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$689.06
|
| Rate for Payer: PHP Commercial |
$780.94
|
| Rate for Payer: Priority Health SBD |
$578.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.19
|
| Rate for Payer: UHC Core |
$478.67
|
| Rate for Payer: UHC Exchange |
$361.07
|
| Rate for Payer: UMR Bronson Commercial |
$339.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.06
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$208.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$187.43 |
| Rate for Payer: Aetna American Axle |
$135.36
|
| Rate for Payer: Aetna Commercial |
$177.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.36
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cofinity Advantage |
$145.78
|
| Rate for Payer: Cofinity Commercial |
$179.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.60
|
| Rate for Payer: Healthscope Commercial |
$187.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.19
|
| Rate for Payer: PHP Commercial |
$177.01
|
| Rate for Payer: Priority Health SBD |
$131.20
|
| Rate for Payer: UMR Bronson Commercial |
$91.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.19
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$7.93
|
|
|
Service Code
|
NDC 00406055223
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna American Axle |
$5.15
|
| Rate for Payer: Aetna Commercial |
$6.74
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.15
|
| Rate for Payer: BCBS Complete |
$3.17
|
| Rate for Payer: Cash Price |
$6.34
|
| Rate for Payer: Cofinity Advantage |
$5.55
|
| Rate for Payer: Cofinity Commercial |
$6.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.34
|
| Rate for Payer: Healthscope Commercial |
$7.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.95
|
| Rate for Payer: PHP Commercial |
$6.74
|
| Rate for Payer: Priority Health SBD |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.15
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.95
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$610.75
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$549.67 |
| Rate for Payer: Aetna American Axle |
$396.99
|
| Rate for Payer: Aetna Commercial |
$519.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.99
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: Cofinity Advantage |
$427.52
|
| Rate for Payer: Cofinity Commercial |
$525.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.60
|
| Rate for Payer: Healthscope Commercial |
$549.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.06
|
| Rate for Payer: PHP Commercial |
$519.14
|
| Rate for Payer: Priority Health SBD |
$384.77
|
| Rate for Payer: UMR Bronson Commercial |
$268.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.06
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
NDC 00406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Medicare |
$162.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: BCBS Complete |
$130.20
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.57
|
| Rate for Payer: UHC Core |
$169.59
|
| Rate for Payer: UHC Exchange |
$127.92
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 00406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UMR Bronson Commercial |
$143.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$792.75
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$348.81 |
| Max. Negotiated Rate |
$713.48 |
| Rate for Payer: Aetna American Axle |
$515.29
|
| Rate for Payer: Aetna Commercial |
$673.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.29
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cofinity Advantage |
$554.92
|
| Rate for Payer: Cofinity Commercial |
$681.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$634.20
|
| Rate for Payer: Healthscope Commercial |
$713.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$554.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$594.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$673.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.56
|
| Rate for Payer: PHP Commercial |
$673.84
|
| Rate for Payer: Priority Health SBD |
$499.43
|
| Rate for Payer: UMR Bronson Commercial |
$348.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$227.50
|
|
|
Service Code
|
NDC 10702001801
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.17 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna American Axle |
$147.88
|
| Rate for Payer: Aetna Commercial |
$193.38
|
| Rate for Payer: Aetna Medicare |
$113.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.88
|
| Rate for Payer: BCBS Complete |
$91.00
|
| Rate for Payer: Cash Price |
$182.00
|
| Rate for Payer: Cofinity Advantage |
$159.25
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.00
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$182.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.62
|
| Rate for Payer: PHP Commercial |
$193.38
|
| Rate for Payer: Priority Health SBD |
$143.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.88
|
| Rate for Payer: UHC Core |
$118.53
|
| Rate for Payer: UHC Exchange |
$89.41
|
| Rate for Payer: UMR Bronson Commercial |
$84.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$610.75
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.98 |
| Max. Negotiated Rate |
$549.67 |
| Rate for Payer: Aetna American Axle |
$396.99
|
| Rate for Payer: Aetna Commercial |
$519.14
|
| Rate for Payer: Aetna Medicare |
$305.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.99
|
| Rate for Payer: BCBS Complete |
$244.30
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: Cofinity Advantage |
$427.52
|
| Rate for Payer: Cofinity Commercial |
$525.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.60
|
| Rate for Payer: Healthscope Commercial |
$549.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$488.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.06
|
| Rate for Payer: PHP Commercial |
$519.14
|
| Rate for Payer: Priority Health SBD |
$384.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.99
|
| Rate for Payer: UHC Core |
$318.20
|
| Rate for Payer: UHC Exchange |
$240.02
|
| Rate for Payer: UMR Bronson Commercial |
$225.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.06
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$610.75
|
|
|
Service Code
|
NDC 68084035401
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$549.67 |
| Rate for Payer: Aetna American Axle |
$396.99
|
| Rate for Payer: Aetna Commercial |
$519.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.99
|
| Rate for Payer: Cash Price |
$488.60
|
| Rate for Payer: Cofinity Advantage |
$427.52
|
| Rate for Payer: Cofinity Commercial |
$525.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$488.60
|
| Rate for Payer: Healthscope Commercial |
$549.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$427.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$458.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.06
|
| Rate for Payer: PHP Commercial |
$519.14
|
| Rate for Payer: Priority Health SBD |
$384.77
|
| Rate for Payer: UMR Bronson Commercial |
$268.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$458.06
|
|
