|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$346.01
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.24 |
| Max. Negotiated Rate |
$311.41 |
| Rate for Payer: Aetna American Axle |
$224.91
|
| Rate for Payer: Aetna Commercial |
$294.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.91
|
| 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: 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: UMR Bronson Commercial |
$152.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.51
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$430.72
|
|
|
Service Code
|
NDC 59011041520
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.52 |
| Max. Negotiated Rate |
$387.65 |
| Rate for Payer: Aetna American Axle |
$279.97
|
| Rate for Payer: Aetna Commercial |
$366.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.97
|
| Rate for Payer: Cash Price |
$344.58
|
| Rate for Payer: Cofinity Advantage |
$301.50
|
| Rate for Payer: Cofinity Commercial |
$370.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.58
|
| Rate for Payer: Healthscope Commercial |
$387.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.04
|
| Rate for Payer: PHP Commercial |
$366.11
|
| Rate for Payer: Priority Health SBD |
$271.35
|
| Rate for Payer: UMR Bronson Commercial |
$189.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.04
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$430.72
|
|
|
Service Code
|
NDC 59011041520
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.37 |
| Max. Negotiated Rate |
$387.65 |
| Rate for Payer: Aetna American Axle |
$279.97
|
| Rate for Payer: Aetna Commercial |
$366.11
|
| Rate for Payer: Aetna Medicare |
$215.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.97
|
| Rate for Payer: BCBS Complete |
$172.29
|
| Rate for Payer: Cash Price |
$344.58
|
| Rate for Payer: Cofinity Advantage |
$301.50
|
| Rate for Payer: Cofinity Commercial |
$370.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.58
|
| Rate for Payer: Healthscope Commercial |
$387.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.04
|
| Rate for Payer: PHP Commercial |
$366.11
|
| Rate for Payer: Priority Health SBD |
$271.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.97
|
| Rate for Payer: UHC Core |
$224.41
|
| Rate for Payer: UHC Exchange |
$169.27
|
| Rate for Payer: UMR Bronson Commercial |
$159.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.04
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$2,099.13
|
|
|
Service Code
|
NDC 59011041510
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$923.62 |
| Max. Negotiated Rate |
$1,889.22 |
| Rate for Payer: Aetna American Axle |
$1,364.43
|
| Rate for Payer: Aetna Commercial |
$1,784.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.43
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: Cofinity Advantage |
$1,469.39
|
| Rate for Payer: Cofinity Commercial |
$1,805.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.30
|
| Rate for Payer: Healthscope Commercial |
$1,889.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,469.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,574.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.35
|
| Rate for Payer: PHP Commercial |
$1,784.26
|
| Rate for Payer: Priority Health SBD |
$1,322.45
|
| Rate for Payer: UMR Bronson Commercial |
$923.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,574.35
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$2,099.13
|
|
|
Service Code
|
NDC 59011041510
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$776.68 |
| Max. Negotiated Rate |
$1,889.22 |
| Rate for Payer: Aetna American Axle |
$1,364.43
|
| Rate for Payer: Aetna Commercial |
$1,784.26
|
| Rate for Payer: Aetna Medicare |
$1,049.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.43
|
| Rate for Payer: BCBS Complete |
$839.65
|
| Rate for Payer: Cash Price |
$1,679.30
|
| Rate for Payer: Cofinity Advantage |
$1,469.39
|
| Rate for Payer: Cofinity Commercial |
$1,805.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,679.30
|
| Rate for Payer: Healthscope Commercial |
$1,889.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,469.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,574.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,679.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,784.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,574.35
|
| Rate for Payer: PHP Commercial |
$1,784.26
|
| Rate for Payer: Priority Health SBD |
$1,322.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,364.43
|
| Rate for Payer: UHC Core |
$1,093.65
|
| Rate for Payer: UHC Exchange |
$824.96
|
| Rate for Payer: UMR Bronson Commercial |
$776.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,574.35
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$545.43
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.81 |
| Max. Negotiated Rate |
$490.89 |
| Rate for Payer: Aetna American Axle |
$354.53
|
| Rate for Payer: Aetna Commercial |
$463.62
|
| Rate for Payer: Aetna Medicare |
$272.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.53
|
| Rate for Payer: BCBS Complete |
$218.17
|
| Rate for Payer: Cash Price |
$436.34
|
| Rate for Payer: Cofinity Advantage |
$381.80
|
| Rate for Payer: Cofinity Commercial |
$469.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.34
|
| Rate for Payer: Healthscope Commercial |
$490.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$436.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.07
|
| Rate for Payer: PHP Commercial |
$463.62
|
| Rate for Payer: Priority Health SBD |
$343.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.53
|
| Rate for Payer: UHC Core |
$284.17
|
| Rate for Payer: UHC Exchange |
$214.35
|
| Rate for Payer: UMR Bronson Commercial |
$201.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.07
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$545.43
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.99 |
| Max. Negotiated Rate |
$490.89 |
| Rate for Payer: Aetna American Axle |
$354.53
|
| Rate for Payer: Aetna Commercial |
$463.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.53
|
| Rate for Payer: Cash Price |
$436.34
|
| Rate for Payer: Cofinity Advantage |
$381.80
|
| Rate for Payer: Cofinity Commercial |
$469.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$436.34
|
| Rate for Payer: Healthscope Commercial |
$490.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$381.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$409.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.07
|
| Rate for Payer: PHP Commercial |
$463.62
|
| Rate for Payer: Priority Health SBD |
$343.62
|
| Rate for Payer: UMR Bronson Commercial |
$239.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$409.07
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$4,553.67
|
|
|
Service Code
|
NDC 59011044010
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,003.61 |
| Max. Negotiated Rate |
$4,098.30 |
| Rate for Payer: Aetna American Axle |
$2,959.89
|
| Rate for Payer: Aetna Commercial |
$3,870.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,959.89
|
| Rate for Payer: Cash Price |
$3,642.94
|
| Rate for Payer: Cofinity Advantage |
$3,187.57
|
| Rate for Payer: Cofinity Commercial |
$3,916.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.94
|
| Rate for Payer: Healthscope Commercial |
$4,098.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,187.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,415.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,870.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,415.25
|
| Rate for Payer: PHP Commercial |
$3,870.62
|
| Rate for Payer: Priority Health SBD |
$2,868.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,003.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,415.25
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$4,553.67
|
|
|
Service Code
|
NDC 59011044010
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,684.86 |
| Max. Negotiated Rate |
$4,098.30 |
| Rate for Payer: Aetna American Axle |
$2,959.89
|
| Rate for Payer: Aetna Commercial |
$3,870.62
|
| Rate for Payer: Aetna Medicare |
$2,276.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,959.89
|
| Rate for Payer: BCBS Complete |
$1,821.47
|
| Rate for Payer: Cash Price |
$3,642.94
|
| Rate for Payer: Cofinity Advantage |
$3,187.57
|
| Rate for Payer: Cofinity Commercial |
$3,916.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,642.94
|
| Rate for Payer: Healthscope Commercial |
$4,098.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,187.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,415.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,642.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,870.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,415.25
|
| Rate for Payer: PHP Commercial |
$3,870.62
|
| Rate for Payer: Priority Health SBD |
$2,868.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,959.89
|
| Rate for Payer: UHC Core |
$2,372.46
|
| Rate for Payer: UHC Exchange |
$1,789.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,684.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,415.25
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$933.77
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$410.86 |
| Max. Negotiated Rate |
$840.39 |
| Rate for Payer: Aetna American Axle |
$606.95
|
| Rate for Payer: Aetna Commercial |
$793.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.95
|
| Rate for Payer: Cash Price |
$747.02
|
| Rate for Payer: Cofinity Advantage |
$653.64
|
| Rate for Payer: Cofinity Commercial |
$803.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.02
|
| Rate for Payer: Healthscope Commercial |
$840.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$653.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$700.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$700.33
|
| Rate for Payer: PHP Commercial |
$793.70
|
| Rate for Payer: Priority Health SBD |
$588.28
|
| Rate for Payer: UMR Bronson Commercial |
$410.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.33
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$933.77
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.49 |
| Max. Negotiated Rate |
$840.39 |
| Rate for Payer: Aetna American Axle |
$606.95
|
| Rate for Payer: Aetna Commercial |
$793.70
|
| Rate for Payer: Aetna Medicare |
$466.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.95
|
| Rate for Payer: BCBS Complete |
$373.51
|
| Rate for Payer: Cash Price |
$747.02
|
| Rate for Payer: Cofinity Advantage |
$653.64
|
| Rate for Payer: Cofinity Commercial |
$803.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$747.02
|
| Rate for Payer: Healthscope Commercial |
$840.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$653.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$700.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$747.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$700.33
|
| Rate for Payer: PHP Commercial |
$793.70
|
| Rate for Payer: Priority Health SBD |
$588.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.95
|
| Rate for Payer: UHC Core |
$486.49
|
| Rate for Payer: UHC Exchange |
$366.97
|
| Rate for Payer: UMR Bronson Commercial |
$345.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$700.33
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$4,136.88
|
|
|
Service Code
|
NDC 00093573401
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,820.23 |
| Max. Negotiated Rate |
$3,723.19 |
| Rate for Payer: Aetna American Axle |
$2,688.97
|
| Rate for Payer: Aetna Commercial |
$3,516.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.97
|
| Rate for Payer: Cash Price |
$3,309.50
|
| Rate for Payer: Cofinity Advantage |
$2,895.82
|
| Rate for Payer: Cofinity Commercial |
$3,557.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,309.50
|
| Rate for Payer: Healthscope Commercial |
$3,723.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,895.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,102.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,516.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,102.66
|
| Rate for Payer: PHP Commercial |
$3,516.35
|
| Rate for Payer: Priority Health SBD |
$2,606.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,820.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,102.66
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$1,630.07
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$603.13 |
| Max. Negotiated Rate |
$1,467.06 |
| Rate for Payer: Aetna American Axle |
$1,059.55
|
| Rate for Payer: Aetna Commercial |
$1,385.56
|
| Rate for Payer: Aetna Medicare |
$815.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.55
|
| Rate for Payer: BCBS Complete |
$652.03
|
| Rate for Payer: Cash Price |
$1,304.06
|
| Rate for Payer: Cofinity Advantage |
$1,141.05
|
| Rate for Payer: Cofinity Commercial |
$1,401.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,304.06
|
| Rate for Payer: Healthscope Commercial |
$1,467.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,141.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,222.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,304.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,222.55
|
| Rate for Payer: PHP Commercial |
$1,385.56
|
| Rate for Payer: Priority Health SBD |
$1,026.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,059.55
|
| Rate for Payer: UHC Core |
$849.27
|
| Rate for Payer: UHC Exchange |
$640.62
|
| Rate for Payer: UMR Bronson Commercial |
$603.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.55
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$7,946.07
|
|
|
Service Code
|
NDC 59011048010
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,496.27 |
| Max. Negotiated Rate |
$7,151.46 |
| Rate for Payer: Aetna American Axle |
$5,164.95
|
| Rate for Payer: Aetna Commercial |
$6,754.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.95
|
| Rate for Payer: Cash Price |
$6,356.86
|
| Rate for Payer: Cofinity Advantage |
$5,562.25
|
| Rate for Payer: Cofinity Commercial |
$6,833.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.86
|
| Rate for Payer: Healthscope Commercial |
$7,151.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,562.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,754.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,959.55
|
| Rate for Payer: PHP Commercial |
$6,754.16
|
| Rate for Payer: Priority Health SBD |
$5,006.02
|
| Rate for Payer: UMR Bronson Commercial |
$3,496.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.55
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,630.07
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$717.23 |
| Max. Negotiated Rate |
$1,467.06 |
| Rate for Payer: Aetna American Axle |
$1,059.55
|
| Rate for Payer: Aetna Commercial |
$1,385.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.55
|
| Rate for Payer: Cash Price |
$1,304.06
|
| Rate for Payer: Cofinity Advantage |
$1,141.05
|
| Rate for Payer: Cofinity Commercial |
$1,401.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,304.06
|
| Rate for Payer: Healthscope Commercial |
$1,467.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,141.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,222.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,222.55
|
| Rate for Payer: PHP Commercial |
$1,385.56
|
| Rate for Payer: Priority Health SBD |
$1,026.94
|
| Rate for Payer: UMR Bronson Commercial |
$717.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,222.55
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$4,136.88
|
|
|
Service Code
|
NDC 00093573401
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,530.65 |
| Max. Negotiated Rate |
$3,723.19 |
| Rate for Payer: Aetna American Axle |
$2,688.97
|
| Rate for Payer: Aetna Commercial |
$3,516.35
|
| Rate for Payer: Aetna Medicare |
$2,068.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.97
|
| Rate for Payer: BCBS Complete |
$1,654.75
|
| Rate for Payer: Cash Price |
$3,309.50
|
| Rate for Payer: Cofinity Advantage |
$2,895.82
|
| Rate for Payer: Cofinity Commercial |
$3,557.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,309.50
|
| Rate for Payer: Healthscope Commercial |
$3,723.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,895.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,102.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,309.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,516.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,102.66
|
| Rate for Payer: PHP Commercial |
$3,516.35
|
| Rate for Payer: Priority Health SBD |
$2,606.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,688.97
|
| Rate for Payer: UHC Core |
$2,155.31
|
| Rate for Payer: UHC Exchange |
$1,625.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,530.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,102.66
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$7,946.07
|
|
|
Service Code
|
NDC 59011048010
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,940.05 |
| Max. Negotiated Rate |
$7,151.46 |
| Rate for Payer: Aetna American Axle |
$5,164.95
|
| Rate for Payer: Aetna Commercial |
$6,754.16
|
| Rate for Payer: Aetna Medicare |
$3,973.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,164.95
|
| Rate for Payer: BCBS Complete |
$3,178.43
|
| Rate for Payer: Cash Price |
$6,356.86
|
| Rate for Payer: Cofinity Advantage |
$5,562.25
|
| Rate for Payer: Cofinity Commercial |
$6,833.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,356.86
|
| Rate for Payer: Healthscope Commercial |
$7,151.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,562.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,959.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,356.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,754.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,959.55
|
| Rate for Payer: PHP Commercial |
$6,754.16
|
| Rate for Payer: Priority Health SBD |
$5,006.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,164.95
|
| Rate for Payer: UHC Core |
$4,139.90
|
| Rate for Payer: UHC Exchange |
$3,122.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,940.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,959.55
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$26.88
|
|
|
Service Code
|
NDC 41100001511
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna American Axle |
$17.47
|
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.47
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.16
|
| Rate for Payer: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.16
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
OP
|
$32.40
|
|
|
Service Code
|
NDC 23900002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna American Axle |
$21.06
|
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.06
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Advantage |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: Priority Health SBD |
$20.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$16.88
|
| Rate for Payer: UHC Exchange |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$11.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
OP
|
$26.88
|
|
|
Service Code
|
NDC 41100001511
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna American Axle |
$17.47
|
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.47
|
| Rate for Payer: BCBS Complete |
$10.75
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.16
|
| Rate for Payer: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.47
|
| Rate for Payer: UHC Core |
$14.00
|
| Rate for Payer: UHC Exchange |
$10.56
|
| Rate for Payer: UMR Bronson Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.16
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$32.40
|
|
|
Service Code
|
NDC 23900002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna American Axle |
$21.06
|
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.06
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Advantage |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: Priority Health SBD |
$20.41
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Advantage |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.63
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$6.89
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
NDC 59390003613
|
| Hospital Charge Code |
5943
|
|
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
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$10.71
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Advantage |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$9.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.03
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: Priority Health SBD |
$6.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
|
