|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna American Axle |
$136.50
|
| Rate for Payer: Aetna Commercial |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.50
|
| 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: 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: UMR Bronson Commercial |
$92.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$484.75
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.29 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna American Axle |
$315.09
|
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Advantage |
$339.32
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health SBD |
$305.39
|
| Rate for Payer: UMR Bronson Commercial |
$213.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$792.75
|
|
|
Service Code
|
NDC 00406055262
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.32 |
| Max. Negotiated Rate |
$713.48 |
| Rate for Payer: Aetna American Axle |
$515.29
|
| Rate for Payer: Aetna Commercial |
$673.84
|
| Rate for Payer: Aetna Medicare |
$396.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.29
|
| Rate for Payer: BCBS Complete |
$317.10
|
| 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: MI Amish Medical Board Commercial |
$634.20
|
| 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: UHC All Payor (Choice/PPO) |
$515.29
|
| Rate for Payer: UHC Core |
$413.02
|
| Rate for Payer: UHC Exchange |
$311.55
|
| Rate for Payer: UMR Bronson Commercial |
$293.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$594.56
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$918.75
|
|
|
Service Code
|
NDC 47781026305
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.25 |
| Max. Negotiated Rate |
$826.88 |
| Rate for Payer: Aetna American Axle |
$597.19
|
| Rate for Payer: Aetna Commercial |
$780.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.19
|
| 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: 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: UMR Bronson Commercial |
$404.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.06
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$733.25
|
|
|
Service Code
|
NDC 42858000110
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$322.63 |
| Max. Negotiated Rate |
$659.92 |
| Rate for Payer: Aetna American Axle |
$476.61
|
| Rate for Payer: Aetna Commercial |
$623.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.61
|
| 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: 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: UMR Bronson Commercial |
$322.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$549.94
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
NDC 57664022388
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Aetna American Axle |
$154.70
|
| Rate for Payer: Aetna Commercial |
$202.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.70
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity 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: 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: UMR Bronson Commercial |
$104.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.50
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$484.75
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.36 |
| Max. Negotiated Rate |
$436.27 |
| Rate for Payer: Aetna American Axle |
$315.09
|
| Rate for Payer: Aetna Commercial |
$412.04
|
| Rate for Payer: Aetna Medicare |
$242.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.09
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: Cash Price |
$387.80
|
| Rate for Payer: Cofinity Advantage |
$339.32
|
| Rate for Payer: Cofinity Commercial |
$416.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.80
|
| Rate for Payer: Healthscope Commercial |
$436.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$339.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.56
|
| Rate for Payer: PHP Commercial |
$412.04
|
| Rate for Payer: Priority Health SBD |
$305.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.09
|
| Rate for Payer: UHC Core |
$252.55
|
| Rate for Payer: UHC Exchange |
$190.51
|
| Rate for Payer: UMR Bronson Commercial |
$179.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.56
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$5.70
|
|
|
Service Code
|
NDC 50268064611
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.71
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Advantage |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.71
|
| Rate for Payer: UHC Core |
$2.97
|
| Rate for Payer: UHC Exchange |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$393.75
|
|
|
Service Code
|
NDC 42858010401
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.25 |
| Max. Negotiated Rate |
$354.38 |
| Rate for Payer: Aetna American Axle |
$255.94
|
| Rate for Payer: Aetna Commercial |
$334.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.94
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cofinity Advantage |
$275.62
|
| Rate for Payer: Cofinity Commercial |
$338.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.00
|
| Rate for Payer: Healthscope Commercial |
$354.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.31
|
| Rate for Payer: PHP Commercial |
$334.69
|
| Rate for Payer: Priority Health SBD |
$248.06
|
| Rate for Payer: UMR Bronson Commercial |
$173.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.31
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$284.55
|
|
|
Service Code
|
NDC 50268064615
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna Medicare |
$142.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: BCBS Complete |
$113.82
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Advantage |
$199.19
|
| Rate for Payer: Cofinity Commercial |
$244.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$256.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.41
|
| Rate for Payer: PHP Commercial |
$241.87
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.96
|
| Rate for Payer: UHC Core |
$148.25
|
| Rate for Payer: UHC Exchange |
$111.83
|
| Rate for Payer: UMR Bronson Commercial |
$105.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$856.05
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna American Axle |
$556.43
|
| Rate for Payer: Aetna Commercial |
$727.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.43
|
| Rate for Payer: Cash Price |
$684.84
|
| Rate for Payer: Cofinity Advantage |
$599.24
|
| Rate for Payer: Cofinity Commercial |
$736.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.84
|
| Rate for Payer: Healthscope Commercial |
$770.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$599.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.04
|
| Rate for Payer: PHP Commercial |
$727.64
|
| Rate for Payer: Priority Health SBD |
$539.31
|
| Rate for Payer: UMR Bronson Commercial |
$376.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.04
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$327.25
|
|
|
Service Code
|
NDC 13107004601
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna American Axle |
$212.71
|
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.71
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cofinity Advantage |
$229.07
|
| Rate for Payer: Cofinity Commercial |
$281.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.80
|
| Rate for Payer: Healthscope Commercial |
$294.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.44
|
| Rate for Payer: PHP Commercial |
$278.16
|
| Rate for Payer: Priority Health SBD |
$206.17
|
| Rate for Payer: UMR Bronson Commercial |
$143.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.44
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$974.40
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$428.74 |
| Max. Negotiated Rate |
$876.96 |
| Rate for Payer: Aetna American Axle |
$633.36
|
| Rate for Payer: Aetna Commercial |
$828.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.36
|
| Rate for Payer: Cash Price |
$779.52
|
| Rate for Payer: Cofinity Advantage |
$682.08
|
| Rate for Payer: Cofinity Commercial |
$837.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.52
|
| Rate for Payer: Healthscope Commercial |
$876.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$730.80
|
| Rate for Payer: PHP Commercial |
$828.24
|
| Rate for Payer: Priority Health SBD |
$613.87
|
| Rate for Payer: UMR Bronson Commercial |
$428.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.80
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$5.70
|
|
|
Service Code
|
NDC 50268064611
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Aetna American Axle |
$3.71
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.71
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cofinity Advantage |
$3.99
|
| Rate for Payer: Cofinity Commercial |
$4.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.56
|
| Rate for Payer: Healthscope Commercial |
$5.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health SBD |
$3.59
|
| Rate for Payer: UMR Bronson Commercial |
$2.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.28
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$8.57
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$7.71 |
| Rate for Payer: Aetna American Axle |
$5.57
|
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.57
|
| Rate for Payer: BCBS Complete |
$3.43
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Advantage |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.28
|
| Rate for Payer: Priority Health SBD |
$5.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.57
|
| Rate for Payer: UHC Core |
$4.46
|
| Rate for Payer: UHC Exchange |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$3.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$8.57
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$7.71 |
| Rate for Payer: Aetna American Axle |
$5.57
|
| Rate for Payer: Aetna Commercial |
$7.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.57
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Advantage |
$6.00
|
| Rate for Payer: Cofinity Commercial |
$7.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.43
|
| Rate for Payer: PHP Commercial |
$7.28
|
| Rate for Payer: Priority Health SBD |
$5.40
|
| Rate for Payer: UMR Bronson Commercial |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$393.75
|
|
|
Service Code
|
NDC 42858010401
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.69 |
| Max. Negotiated Rate |
$354.38 |
| Rate for Payer: Aetna American Axle |
$255.94
|
| Rate for Payer: Aetna Commercial |
$334.69
|
| Rate for Payer: Aetna Medicare |
$196.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.94
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cofinity Advantage |
$275.62
|
| Rate for Payer: Cofinity Commercial |
$338.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.00
|
| Rate for Payer: Healthscope Commercial |
$354.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.31
|
| Rate for Payer: PHP Commercial |
$334.69
|
| Rate for Payer: Priority Health SBD |
$248.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.94
|
| Rate for Payer: UHC Core |
$205.14
|
| Rate for Payer: UHC Exchange |
$154.74
|
| Rate for Payer: UMR Bronson Commercial |
$145.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.31
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 00406052301
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cofinity 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-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$856.05
|
|
|
Service Code
|
NDC 00406052362
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$316.74 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna American Axle |
$556.43
|
| Rate for Payer: Aetna Commercial |
$727.64
|
| Rate for Payer: Aetna Medicare |
$428.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.43
|
| Rate for Payer: BCBS Complete |
$342.42
|
| Rate for Payer: Cash Price |
$684.84
|
| Rate for Payer: Cofinity Advantage |
$599.24
|
| Rate for Payer: Cofinity Commercial |
$736.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.84
|
| Rate for Payer: Healthscope Commercial |
$770.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$599.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$642.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$684.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$642.04
|
| Rate for Payer: PHP Commercial |
$727.64
|
| Rate for Payer: Priority Health SBD |
$539.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.43
|
| Rate for Payer: UHC Core |
$446.00
|
| Rate for Payer: UHC Exchange |
$336.43
|
| Rate for Payer: UMR Bronson Commercial |
$316.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$642.04
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$284.55
|
|
|
Service Code
|
NDC 50268064615
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$256.10 |
| Rate for Payer: Aetna American Axle |
$184.96
|
| Rate for Payer: Aetna Commercial |
$241.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.96
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Advantage |
$199.19
|
| Rate for Payer: Cofinity Commercial |
$244.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$256.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.41
|
| Rate for Payer: PHP Commercial |
$241.87
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UMR Bronson Commercial |
$125.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.41
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$327.25
|
|
|
Service Code
|
NDC 13107004601
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna American Axle |
$212.71
|
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare |
$163.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.71
|
| Rate for Payer: BCBS Complete |
$130.90
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cofinity Advantage |
$229.07
|
| Rate for Payer: Cofinity Commercial |
$281.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.80
|
| Rate for Payer: Healthscope Commercial |
$294.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.44
|
| Rate for Payer: PHP Commercial |
$278.16
|
| Rate for Payer: Priority Health SBD |
$206.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.71
|
| Rate for Payer: UHC Core |
$170.50
|
| Rate for Payer: UHC Exchange |
$128.61
|
| Rate for Payer: UMR Bronson Commercial |
$121.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.44
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$803.25
|
|
|
Service Code
|
NDC 00406052301
|
| Hospital Charge Code |
31864
|
|
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-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$974.40
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.53 |
| Max. Negotiated Rate |
$876.96 |
| Rate for Payer: Aetna American Axle |
$633.36
|
| Rate for Payer: Aetna Commercial |
$828.24
|
| Rate for Payer: Aetna Medicare |
$487.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.36
|
| Rate for Payer: BCBS Complete |
$389.76
|
| Rate for Payer: Cash Price |
$779.52
|
| Rate for Payer: Cofinity Advantage |
$682.08
|
| Rate for Payer: Cofinity Commercial |
$837.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$779.52
|
| Rate for Payer: Healthscope Commercial |
$876.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$730.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$779.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$730.80
|
| Rate for Payer: PHP Commercial |
$828.24
|
| Rate for Payer: Priority Health SBD |
$613.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.36
|
| Rate for Payer: UHC Core |
$507.66
|
| Rate for Payer: UHC Exchange |
$382.94
|
| Rate for Payer: UMR Bronson Commercial |
$360.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$730.80
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$269.50
|
|
|
Service Code
|
NDC 42858010201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.72 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna American Axle |
$175.18
|
| Rate for Payer: Aetna Commercial |
$229.07
|
| Rate for Payer: Aetna Medicare |
$134.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.18
|
| Rate for Payer: BCBS Complete |
$107.80
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cofinity Advantage |
$188.65
|
| Rate for Payer: Cofinity Commercial |
$231.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.60
|
| Rate for Payer: Healthscope Commercial |
$242.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.12
|
| Rate for Payer: PHP Commercial |
$229.07
|
| Rate for Payer: Priority Health SBD |
$169.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.18
|
| Rate for Payer: UHC Core |
$140.41
|
| Rate for Payer: UHC Exchange |
$105.91
|
| Rate for Payer: UMR Bronson Commercial |
$99.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.12
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
