|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00832003800
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna American Axle |
$196.37
|
| Rate for Payer: Aetna Commercial |
$256.79
|
| Rate for Payer: Aetna Medicare |
$151.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.37
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$211.47
|
| Rate for Payer: Cofinity Commercial |
$259.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$271.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: PHP Commercial |
$256.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| Rate for Payer: Priority Health SBD |
$190.32
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.57
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$421.25
|
|
|
Service Code
|
NDC 50268062815
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.35 |
| Max. Negotiated Rate |
$379.12 |
| Rate for Payer: Aetna American Axle |
$273.81
|
| Rate for Payer: Aetna Commercial |
$358.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.81
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cofinity Commercial |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$362.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.00
|
| Rate for Payer: Healthscope Commercial |
$379.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.06
|
| Rate for Payer: PHP Commercial |
$358.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.81
|
| Rate for Payer: Priority Health SBD |
$265.39
|
| Rate for Payer: UMR Bronson Commercial |
$185.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.94
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$257.19
|
|
|
Service Code
|
NDC 68084061021
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.16 |
| Max. Negotiated Rate |
$231.47 |
| Rate for Payer: Aetna American Axle |
$167.17
|
| Rate for Payer: Aetna Commercial |
$218.61
|
| Rate for Payer: Aetna Medicare |
$128.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.17
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: Cash Price |
$205.75
|
| Rate for Payer: Cofinity Commercial |
$180.03
|
| Rate for Payer: Cofinity Commercial |
$221.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.75
|
| Rate for Payer: Healthscope Commercial |
$231.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.61
|
| Rate for Payer: PHP Commercial |
$218.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.17
|
| Rate for Payer: Priority Health SBD |
$162.03
|
| Rate for Payer: UMR Bronson Commercial |
$95.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.89
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$421.25
|
|
|
Service Code
|
NDC 50268062815
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.86 |
| Max. Negotiated Rate |
$379.12 |
| Rate for Payer: Aetna American Axle |
$273.81
|
| Rate for Payer: Aetna Commercial |
$358.06
|
| Rate for Payer: Aetna Medicare |
$210.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.81
|
| Rate for Payer: BCBS Complete |
$168.50
|
| Rate for Payer: Cash Price |
$337.00
|
| Rate for Payer: Cofinity Commercial |
$294.88
|
| Rate for Payer: Cofinity Commercial |
$362.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.00
|
| Rate for Payer: Healthscope Commercial |
$379.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.06
|
| Rate for Payer: PHP Commercial |
$358.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.81
|
| Rate for Payer: Priority Health SBD |
$265.39
|
| Rate for Payer: UMR Bronson Commercial |
$155.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.94
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.58
|
|
|
Service Code
|
NDC 68084061011
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna American Axle |
$5.58
|
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.58
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$7.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.29
|
| Rate for Payer: PHP Commercial |
$7.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health SBD |
$5.41
|
| Rate for Payer: UMR Bronson Commercial |
$3.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$257.19
|
|
|
Service Code
|
NDC 68084061021
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$231.47 |
| Rate for Payer: Aetna American Axle |
$167.17
|
| Rate for Payer: Aetna Commercial |
$218.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.17
|
| Rate for Payer: Cash Price |
$205.75
|
| Rate for Payer: Cofinity Commercial |
$180.03
|
| Rate for Payer: Cofinity Commercial |
$221.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.75
|
| Rate for Payer: Healthscope Commercial |
$231.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.61
|
| Rate for Payer: PHP Commercial |
$218.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.17
|
| Rate for Payer: Priority Health SBD |
$162.03
|
| Rate for Payer: UMR Bronson Commercial |
$113.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.89
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$8.43
|
|
|
Service Code
|
NDC 50268062811
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna American Axle |
$5.48
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.48
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.17
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.48
|
| Rate for Payer: Priority Health SBD |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.32
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.58
|
|
|
Service Code
|
NDC 68084061011
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$7.72 |
| Rate for Payer: Aetna American Axle |
$5.58
|
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.58
|
| Rate for Payer: BCBS Complete |
$3.43
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cofinity Commercial |
$6.01
|
| Rate for Payer: Cofinity Commercial |
$7.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.86
|
| Rate for Payer: Healthscope Commercial |
$7.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.29
|
| Rate for Payer: PHP Commercial |
$7.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.58
|
| Rate for Payer: Priority Health SBD |
$5.41
|
| Rate for Payer: UMR Bronson Commercial |
$3.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.43
|
|
|
OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$8.43
|
|
|
Service Code
|
NDC 50268062811
|
| Hospital Charge Code |
24471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Aetna American Axle |
$5.48
|
| Rate for Payer: Aetna Commercial |
$7.17
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.48
|
| Rate for Payer: BCBS Complete |
$3.37
|
| Rate for Payer: Cash Price |
$6.74
|
| Rate for Payer: Cofinity Commercial |
$5.90
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.17
|
| Rate for Payer: PHP Commercial |
$7.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.48
|
| Rate for Payer: Priority Health SBD |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.32
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$572.16
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.75 |
| Max. Negotiated Rate |
$514.94 |
| Rate for Payer: Aetna American Axle |
$371.90
|
| Rate for Payer: Aetna Commercial |
$486.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.90
|
| Rate for Payer: Cash Price |
$457.73
|
| Rate for Payer: Cofinity Commercial |
$400.51
|
| Rate for Payer: Cofinity Commercial |
$492.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$400.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.73
|
| Rate for Payer: Healthscope Commercial |
$514.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.34
|
| Rate for Payer: PHP Commercial |
$486.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.90
|
| Rate for Payer: Priority Health SBD |
$360.46
|
| Rate for Payer: UMR Bronson Commercial |
$251.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.12
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$572.16
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.70 |
| Max. Negotiated Rate |
$514.94 |
| Rate for Payer: Aetna American Axle |
$371.90
|
| Rate for Payer: Aetna Commercial |
$486.34
|
| Rate for Payer: Aetna Medicare |
$286.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.90
|
| Rate for Payer: BCBS Complete |
$228.86
|
| Rate for Payer: Cash Price |
$457.73
|
| Rate for Payer: Cofinity Commercial |
$400.51
|
| Rate for Payer: Cofinity Commercial |
$492.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$400.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.73
|
| Rate for Payer: Healthscope Commercial |
$514.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$400.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.34
|
| Rate for Payer: PHP Commercial |
$486.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.90
|
| Rate for Payer: Priority Health SBD |
$360.46
|
| Rate for Payer: UMR Bronson Commercial |
$211.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.12
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.26 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna American Axle |
$146.64
|
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UMR Bronson Commercial |
$99.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$203.04 |
| Rate for Payer: Aetna American Axle |
$146.64
|
| Rate for Payer: Aetna Commercial |
$191.76
|
| Rate for Payer: Aetna Medicare |
$112.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.64
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Cofinity Commercial |
$194.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$203.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: PHP Commercial |
$191.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health SBD |
$142.13
|
| Rate for Payer: UMR Bronson Commercial |
$83.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.20
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
NDC 00406851501
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna American Axle |
$336.70
|
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.70
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$362.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health SBD |
$326.34
|
| Rate for Payer: UMR Bronson Commercial |
$227.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.50
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$351.75
|
|
|
Service Code
|
NDC 42858000301
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$316.57 |
| Rate for Payer: Aetna American Axle |
$228.64
|
| Rate for Payer: Aetna Commercial |
$298.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.64
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cofinity Commercial |
$246.22
|
| Rate for Payer: Cofinity Commercial |
$302.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.40
|
| Rate for Payer: Healthscope Commercial |
$316.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.99
|
| Rate for Payer: PHP Commercial |
$298.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.64
|
| Rate for Payer: Priority Health SBD |
$221.60
|
| Rate for Payer: UMR Bronson Commercial |
$154.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.81
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$351.75
|
|
|
Service Code
|
NDC 42858000301
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$316.57 |
| Rate for Payer: Aetna American Axle |
$228.64
|
| Rate for Payer: Aetna Commercial |
$298.99
|
| Rate for Payer: Aetna Medicare |
$175.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.64
|
| Rate for Payer: BCBS Complete |
$140.70
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cofinity Commercial |
$246.22
|
| Rate for Payer: Cofinity Commercial |
$302.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$246.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.40
|
| Rate for Payer: Healthscope Commercial |
$316.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.99
|
| Rate for Payer: PHP Commercial |
$298.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.64
|
| Rate for Payer: Priority Health SBD |
$221.60
|
| Rate for Payer: UMR Bronson Commercial |
$130.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.81
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$705.25
|
|
|
Service Code
|
NDC 47781026401
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.94 |
| Max. Negotiated Rate |
$634.73 |
| Rate for Payer: Aetna American Axle |
$458.41
|
| Rate for Payer: Aetna Commercial |
$599.46
|
| Rate for Payer: Aetna Medicare |
$352.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.41
|
| Rate for Payer: BCBS Complete |
$282.10
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cofinity Commercial |
$493.68
|
| Rate for Payer: Cofinity Commercial |
$606.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.20
|
| Rate for Payer: Healthscope Commercial |
$634.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.46
|
| Rate for Payer: PHP Commercial |
$599.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.41
|
| Rate for Payer: Priority Health SBD |
$444.31
|
| Rate for Payer: UMR Bronson Commercial |
$260.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.94
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$705.25
|
|
|
Service Code
|
NDC 47781026401
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.31 |
| Max. Negotiated Rate |
$634.73 |
| Rate for Payer: Aetna American Axle |
$458.41
|
| Rate for Payer: Aetna Commercial |
$599.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.41
|
| Rate for Payer: Cash Price |
$564.20
|
| Rate for Payer: Cofinity Commercial |
$493.68
|
| Rate for Payer: Cofinity Commercial |
$606.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$493.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$564.20
|
| Rate for Payer: Healthscope Commercial |
$634.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.46
|
| Rate for Payer: PHP Commercial |
$599.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.41
|
| Rate for Payer: Priority Health SBD |
$444.31
|
| Rate for Payer: UMR Bronson Commercial |
$310.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.94
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$339.50
|
|
|
Service Code
|
NDC 57664018788
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.61 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Aetna American Axle |
$220.68
|
| Rate for Payer: Aetna Commercial |
$288.57
|
| Rate for Payer: Aetna Medicare |
$169.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: BCBS Complete |
$135.80
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Cofinity Commercial |
$291.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.60
|
| Rate for Payer: Healthscope Commercial |
$305.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.57
|
| Rate for Payer: PHP Commercial |
$288.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.68
|
| Rate for Payer: Priority Health SBD |
$213.88
|
| Rate for Payer: UMR Bronson Commercial |
$125.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.62
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
NDC 00406851501
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.66 |
| Max. Negotiated Rate |
$466.20 |
| Rate for Payer: Aetna American Axle |
$336.70
|
| Rate for Payer: Aetna Commercial |
$440.30
|
| Rate for Payer: Aetna Medicare |
$259.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.70
|
| Rate for Payer: BCBS Complete |
$207.20
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$362.60
|
| Rate for Payer: Cofinity Commercial |
$445.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$362.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.40
|
| Rate for Payer: Healthscope Commercial |
$466.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.30
|
| Rate for Payer: PHP Commercial |
$440.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health SBD |
$326.34
|
| Rate for Payer: UMR Bronson Commercial |
$191.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.50
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$339.50
|
|
|
Service Code
|
NDC 57664018788
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.38 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Aetna American Axle |
$220.68
|
| Rate for Payer: Aetna Commercial |
$288.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.68
|
| Rate for Payer: Cash Price |
$271.60
|
| Rate for Payer: Cofinity Commercial |
$237.65
|
| Rate for Payer: Cofinity Commercial |
$291.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.60
|
| Rate for Payer: Healthscope Commercial |
$305.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.57
|
| Rate for Payer: PHP Commercial |
$288.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.68
|
| Rate for Payer: Priority Health SBD |
$213.88
|
| Rate for Payer: UMR Bronson Commercial |
$149.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.62
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
NDC 65162004910
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna American Axle |
$250.25
|
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.25
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cofinity Commercial |
$269.50
|
| Rate for Payer: Cofinity Commercial |
$331.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.00
|
| Rate for Payer: Healthscope Commercial |
$346.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.25
|
| Rate for Payer: PHP Commercial |
$327.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.25
|
| Rate for Payer: Priority Health SBD |
$242.55
|
| Rate for Payer: UMR Bronson Commercial |
$169.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.75
|
|
|
OXYCODONE 15 MG TABLET
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
NDC 65162004910
|
| Hospital Charge Code |
28899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.45 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna American Axle |
$250.25
|
| Rate for Payer: Aetna Commercial |
$327.25
|
| Rate for Payer: Aetna Medicare |
$192.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.25
|
| Rate for Payer: BCBS Complete |
$154.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cofinity Commercial |
$269.50
|
| Rate for Payer: Cofinity Commercial |
$331.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$269.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$308.00
|
| Rate for Payer: Healthscope Commercial |
$346.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$269.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.25
|
| Rate for Payer: PHP Commercial |
$327.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.25
|
| Rate for Payer: Priority Health SBD |
$242.55
|
| Rate for Payer: UMR Bronson Commercial |
$142.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.75
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$729.75
|
|
|
Service Code
|
NDC 65162005110
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.09 |
| Max. Negotiated Rate |
$656.77 |
| Rate for Payer: Aetna American Axle |
$474.34
|
| Rate for Payer: Aetna Commercial |
$620.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.34
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$510.82
|
| Rate for Payer: Cofinity Commercial |
$627.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.80
|
| Rate for Payer: Healthscope Commercial |
$656.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.29
|
| Rate for Payer: PHP Commercial |
$620.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.34
|
| Rate for Payer: Priority Health SBD |
$459.74
|
| Rate for Payer: UMR Bronson Commercial |
$321.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.31
|
|
