|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$269.50
|
|
|
Service Code
|
NDC 42858010201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna American Axle |
$175.18
|
| Rate for Payer: Aetna Commercial |
$229.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.18
|
| 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: 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: UMR Bronson Commercial |
$118.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.12
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$656.25
|
|
|
Service Code
|
NDC 60687064201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.75 |
| Max. Negotiated Rate |
$590.62 |
| Rate for Payer: Aetna American Axle |
$426.56
|
| Rate for Payer: Aetna Commercial |
$557.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.56
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cofinity Advantage |
$459.38
|
| Rate for Payer: Cofinity Commercial |
$564.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.00
|
| Rate for Payer: Healthscope Commercial |
$590.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.19
|
| Rate for Payer: PHP Commercial |
$557.81
|
| Rate for Payer: Priority Health SBD |
$413.44
|
| Rate for Payer: UMR Bronson Commercial |
$288.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.19
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 60687064211
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Advantage |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.93
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| 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: MI Amish Medical Board Commercial |
$65.80
|
| 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: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
| Rate for Payer: UMR Bronson Commercial |
$30.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$656.25
|
|
|
Service Code
|
NDC 60687064201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.81 |
| Max. Negotiated Rate |
$590.62 |
| Rate for Payer: Aetna American Axle |
$426.56
|
| Rate for Payer: Aetna Commercial |
$557.81
|
| Rate for Payer: Aetna Medicare |
$328.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.56
|
| Rate for Payer: BCBS Complete |
$262.50
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cofinity Advantage |
$459.38
|
| Rate for Payer: Cofinity Commercial |
$564.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$525.00
|
| Rate for Payer: Healthscope Commercial |
$590.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$459.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$492.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$525.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$557.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$492.19
|
| Rate for Payer: PHP Commercial |
$557.81
|
| Rate for Payer: Priority Health SBD |
$413.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.56
|
| Rate for Payer: UHC Core |
$341.91
|
| Rate for Payer: UHC Exchange |
$257.91
|
| Rate for Payer: UMR Bronson Commercial |
$242.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$492.19
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,452.50
|
|
|
Service Code
|
NDC 00406051205
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$639.10 |
| Max. Negotiated Rate |
$1,307.25 |
| Rate for Payer: Aetna American Axle |
$944.12
|
| Rate for Payer: Aetna Commercial |
$1,234.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.12
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cofinity Advantage |
$1,016.75
|
| Rate for Payer: Cofinity Commercial |
$1,249.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.00
|
| Rate for Payer: Healthscope Commercial |
$1,307.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,016.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,234.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,089.38
|
| Rate for Payer: PHP Commercial |
$1,234.62
|
| Rate for Payer: Priority Health SBD |
$915.08
|
| Rate for Payer: UMR Bronson Commercial |
$639.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.38
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$1,452.50
|
|
|
Service Code
|
NDC 00406051205
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.42 |
| Max. Negotiated Rate |
$1,307.25 |
| Rate for Payer: Aetna American Axle |
$944.12
|
| Rate for Payer: Aetna Commercial |
$1,234.62
|
| Rate for Payer: Aetna Medicare |
$726.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.12
|
| Rate for Payer: BCBS Complete |
$581.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cofinity Advantage |
$1,016.75
|
| Rate for Payer: Cofinity Commercial |
$1,249.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.00
|
| Rate for Payer: Healthscope Commercial |
$1,307.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,016.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,234.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,089.38
|
| Rate for Payer: PHP Commercial |
$1,234.62
|
| Rate for Payer: Priority Health SBD |
$915.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$944.12
|
| Rate for Payer: UHC Core |
$756.75
|
| Rate for Payer: UHC Exchange |
$570.83
|
| Rate for Payer: UMR Bronson Commercial |
$537.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.38
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$290.50
|
|
|
Service Code
|
NDC 00406051201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: Cash Price |
$232.40
|
| Rate for Payer: Cofinity Advantage |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.40
|
| Rate for Payer: Healthscope Commercial |
$261.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.88
|
| Rate for Payer: PHP Commercial |
$246.93
|
| Rate for Payer: Priority Health SBD |
$183.01
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
NDC 60687064211
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna Medicare |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: BCBS Complete |
$2.63
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Advantage |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.93
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.27
|
| Rate for Payer: UHC Core |
$3.42
|
| Rate for Payer: UHC Exchange |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$290.50
|
|
|
Service Code
|
NDC 00406051201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.93
|
| Rate for Payer: Aetna Medicare |
$145.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: BCBS Complete |
$116.20
|
| Rate for Payer: Cash Price |
$232.40
|
| Rate for Payer: Cofinity Advantage |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.40
|
| Rate for Payer: Healthscope Commercial |
$261.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.88
|
| Rate for Payer: PHP Commercial |
$246.93
|
| Rate for Payer: Priority Health SBD |
$183.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.82
|
| Rate for Payer: UHC Core |
$151.35
|
| Rate for Payer: UHC Exchange |
$114.17
|
| Rate for Payer: UMR Bronson Commercial |
$107.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$13.06
|
|
|
Service Code
|
NDC 00406052223
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$11.75 |
| Rate for Payer: Aetna American Axle |
$8.49
|
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: Aetna Medicare |
$6.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.49
|
| Rate for Payer: BCBS Complete |
$5.22
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Advantage |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$11.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: PHP Commercial |
$11.10
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.49
|
| Rate for Payer: UHC Core |
$6.80
|
| Rate for Payer: UHC Exchange |
$5.13
|
| Rate for Payer: UMR Bronson Commercial |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$10,169.61
|
|
|
Service Code
|
NDC 63481062870
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,762.76 |
| Max. Negotiated Rate |
$9,152.65 |
| Rate for Payer: Aetna American Axle |
$6,610.25
|
| Rate for Payer: Aetna Commercial |
$8,644.17
|
| Rate for Payer: Aetna Medicare |
$5,084.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,610.25
|
| Rate for Payer: BCBS Complete |
$4,067.84
|
| Rate for Payer: Cash Price |
$8,135.69
|
| Rate for Payer: Cofinity Advantage |
$7,118.73
|
| Rate for Payer: Cofinity Commercial |
$8,745.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,135.69
|
| Rate for Payer: Healthscope Commercial |
$9,152.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,118.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,627.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,135.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,644.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,627.21
|
| Rate for Payer: PHP Commercial |
$8,644.17
|
| Rate for Payer: Priority Health SBD |
$6,406.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,610.25
|
| Rate for Payer: UHC Core |
$5,298.37
|
| Rate for Payer: UHC Exchange |
$3,996.66
|
| Rate for Payer: UMR Bronson Commercial |
$3,762.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,627.21
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 00406052201
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cofinity 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 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,305.50
|
|
|
Service Code
|
NDC 00406052262
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$574.42 |
| Max. Negotiated Rate |
$1,174.95 |
| Rate for Payer: Aetna American Axle |
$848.58
|
| Rate for Payer: Aetna Commercial |
$1,109.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.58
|
| Rate for Payer: Cash Price |
$1,044.40
|
| Rate for Payer: Cofinity Advantage |
$913.85
|
| Rate for Payer: Cofinity Commercial |
$1,122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.40
|
| Rate for Payer: Healthscope Commercial |
$1,174.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$913.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$979.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$979.12
|
| Rate for Payer: PHP Commercial |
$1,109.67
|
| Rate for Payer: Priority Health SBD |
$822.47
|
| Rate for Payer: UMR Bronson Commercial |
$574.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$979.12
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$5.55
|
|
|
Service Code
|
NDC 50268064511
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: Cash Price |
$4.44
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.72
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$10,169.61
|
|
|
Service Code
|
NDC 63481062870
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,474.63 |
| Max. Negotiated Rate |
$9,152.65 |
| Rate for Payer: Aetna American Axle |
$6,610.25
|
| Rate for Payer: Aetna Commercial |
$8,644.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,610.25
|
| Rate for Payer: Cash Price |
$8,135.69
|
| Rate for Payer: Cofinity Advantage |
$7,118.73
|
| Rate for Payer: Cofinity Commercial |
$8,745.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,135.69
|
| Rate for Payer: Healthscope Commercial |
$9,152.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,118.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,627.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,644.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,627.21
|
| Rate for Payer: PHP Commercial |
$8,644.17
|
| Rate for Payer: Priority Health SBD |
$6,406.85
|
| Rate for Payer: UMR Bronson Commercial |
$4,474.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,627.21
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$1,305.50
|
|
|
Service Code
|
NDC 00406052262
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.04 |
| Max. Negotiated Rate |
$1,174.95 |
| Rate for Payer: Aetna American Axle |
$848.58
|
| Rate for Payer: Aetna Commercial |
$1,109.67
|
| Rate for Payer: Aetna Medicare |
$652.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.58
|
| Rate for Payer: BCBS Complete |
$522.20
|
| Rate for Payer: Cash Price |
$1,044.40
|
| Rate for Payer: Cofinity Advantage |
$913.85
|
| Rate for Payer: Cofinity Commercial |
$1,122.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,044.40
|
| Rate for Payer: Healthscope Commercial |
$1,174.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$913.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$979.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,044.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,109.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$979.12
|
| Rate for Payer: PHP Commercial |
$1,109.67
|
| Rate for Payer: Priority Health SBD |
$822.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.58
|
| Rate for Payer: UHC Core |
$680.17
|
| Rate for Payer: UHC Exchange |
$513.06
|
| Rate for Payer: UMR Bronson Commercial |
$483.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$979.12
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$803.25
|
|
|
Service Code
|
NDC 00406052201
|
| Hospital Charge Code |
31863
|
|
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 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 47781022901
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.82 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.57
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UMR Bronson Commercial |
$204.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$5.55
|
|
|
Service Code
|
NDC 50268064511
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna Commercial |
$4.72
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: Cash Price |
$4.44
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.72
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.61
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$13.06
|
|
|
Service Code
|
NDC 00406052223
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$11.75 |
| Rate for Payer: Aetna American Axle |
$8.49
|
| Rate for Payer: Aetna Commercial |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.49
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cofinity Advantage |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.45
|
| Rate for Payer: Healthscope Commercial |
$11.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.79
|
| Rate for Payer: PHP Commercial |
$11.10
|
| Rate for Payer: Priority Health SBD |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 47781022901
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.57
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$232.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.57
|
| Rate for Payer: UHC Core |
$242.53
|
| Rate for Payer: UHC Exchange |
$182.94
|
| Rate for Payer: UMR Bronson Commercial |
$172.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$877.11
|
|
|
Service Code
|
NDC 00093573101
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.53 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna American Axle |
$570.12
|
| Rate for Payer: Aetna Commercial |
$745.54
|
| Rate for Payer: Aetna Medicare |
$438.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.12
|
| Rate for Payer: BCBS Complete |
$350.84
|
| Rate for Payer: Cash Price |
$701.69
|
| Rate for Payer: Cofinity Advantage |
$613.98
|
| Rate for Payer: Cofinity Commercial |
$754.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.69
|
| Rate for Payer: Healthscope Commercial |
$789.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$701.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.83
|
| Rate for Payer: PHP Commercial |
$745.54
|
| Rate for Payer: Priority Health SBD |
$552.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.12
|
| Rate for Payer: UHC Core |
$456.97
|
| Rate for Payer: UHC Exchange |
$344.70
|
| Rate for Payer: UMR Bronson Commercial |
$324.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.83
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$346.01
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.02 |
| Max. Negotiated Rate |
$311.41 |
| Rate for Payer: Aetna American Axle |
$224.91
|
| Rate for Payer: Aetna Commercial |
$294.11
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.91
|
| Rate for Payer: BCBS Complete |
$138.40
|
| Rate for Payer: Cash Price |
$276.81
|
| Rate for Payer: Cofinity Advantage |
$242.21
|
| Rate for Payer: Cofinity Commercial |
$297.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.81
|
| Rate for Payer: Healthscope Commercial |
$311.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$242.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$294.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.51
|
| Rate for Payer: PHP Commercial |
$294.11
|
| Rate for Payer: Priority Health SBD |
$217.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.91
|
| Rate for Payer: UHC Core |
$180.27
|
| Rate for Payer: UHC Exchange |
$135.98
|
| Rate for Payer: UMR Bronson Commercial |
$128.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.51
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$877.11
|
|
|
Service Code
|
NDC 00093573101
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.93 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna American Axle |
$570.12
|
| Rate for Payer: Aetna Commercial |
$745.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.12
|
| Rate for Payer: Cash Price |
$701.69
|
| Rate for Payer: Cofinity Advantage |
$613.98
|
| Rate for Payer: Cofinity Commercial |
$754.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.69
|
| Rate for Payer: Healthscope Commercial |
$789.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$657.83
|
| Rate for Payer: PHP Commercial |
$745.54
|
| Rate for Payer: Priority Health SBD |
$552.58
|
| Rate for Payer: UMR Bronson Commercial |
$385.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.83
|
|
