|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
OP
|
$592.32
|
|
|
Service Code
|
NDC 68084086701
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.16 |
| Max. Negotiated Rate |
$533.09 |
| Rate for Payer: Aetna American Axle |
$385.01
|
| Rate for Payer: Aetna Commercial |
$503.47
|
| Rate for Payer: Aetna Medicare |
$296.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.01
|
| Rate for Payer: BCBS Complete |
$236.93
|
| Rate for Payer: Cash Price |
$473.86
|
| Rate for Payer: Cofinity Commercial |
$414.62
|
| Rate for Payer: Cofinity Commercial |
$509.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$414.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$473.86
|
| Rate for Payer: Healthscope Commercial |
$533.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$414.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$444.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$503.47
|
| Rate for Payer: PHP Commercial |
$503.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.01
|
| Rate for Payer: Priority Health SBD |
$373.16
|
| Rate for Payer: UMR Bronson Commercial |
$219.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$444.24
|
|
|
OXCARBAZEPINE 600 MG TABLET
|
Facility
|
OP
|
$5.93
|
|
|
Service Code
|
NDC 68084086711
|
| Hospital Charge Code |
21157
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Aetna American Axle |
$3.85
|
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.85
|
| Rate for Payer: BCBS Complete |
$2.37
|
| Rate for Payer: Cash Price |
$4.74
|
| Rate for Payer: Cofinity Commercial |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$5.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.74
|
| Rate for Payer: Healthscope Commercial |
$5.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.04
|
| Rate for Payer: PHP Commercial |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.85
|
| Rate for Payer: Priority Health SBD |
$3.74
|
| Rate for Payer: UMR Bronson Commercial |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.45
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$7,902.83
|
|
|
Service Code
|
NDC 17772012301
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,924.05 |
| Max. Negotiated Rate |
$7,112.55 |
| Rate for Payer: Aetna American Axle |
$5,136.84
|
| Rate for Payer: Aetna Commercial |
$6,717.41
|
| Rate for Payer: Aetna Medicare |
$3,951.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,136.84
|
| Rate for Payer: BCBS Complete |
$3,161.13
|
| Rate for Payer: Cash Price |
$6,322.26
|
| Rate for Payer: Cofinity Commercial |
$5,531.98
|
| Rate for Payer: Cofinity Commercial |
$6,796.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,531.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,322.26
|
| Rate for Payer: Healthscope Commercial |
$7,112.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,531.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,927.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,717.41
|
| Rate for Payer: PHP Commercial |
$6,717.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,136.84
|
| Rate for Payer: Priority Health SBD |
$4,978.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,924.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,927.12
|
|
|
OXCARBAZEPINE ER 600 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$7,902.83
|
|
|
Service Code
|
NDC 17772012301
|
| Hospital Charge Code |
163678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,477.25 |
| Max. Negotiated Rate |
$7,112.55 |
| Rate for Payer: Aetna American Axle |
$5,136.84
|
| Rate for Payer: Aetna Commercial |
$6,717.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,136.84
|
| Rate for Payer: Cash Price |
$6,322.26
|
| Rate for Payer: Cofinity Commercial |
$5,531.98
|
| Rate for Payer: Cofinity Commercial |
$6,796.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,531.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,322.26
|
| Rate for Payer: Healthscope Commercial |
$7,112.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,531.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,927.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,717.41
|
| Rate for Payer: PHP Commercial |
$6,717.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,136.84
|
| Rate for Payer: Priority Health SBD |
$4,978.78
|
| Rate for Payer: UMR Bronson Commercial |
$3,477.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,927.12
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$444.62
|
|
|
Service Code
|
NDC 60432009216
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.63 |
| Max. Negotiated Rate |
$400.16 |
| Rate for Payer: Aetna American Axle |
$289.00
|
| Rate for Payer: Aetna Commercial |
$377.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.00
|
| Rate for Payer: Cash Price |
$355.70
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Commercial |
$382.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.70
|
| Rate for Payer: Healthscope Commercial |
$400.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.93
|
| Rate for Payer: PHP Commercial |
$377.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.00
|
| Rate for Payer: Priority Health SBD |
$280.11
|
| Rate for Payer: UMR Bronson Commercial |
$195.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.46
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$444.62
|
|
|
Service Code
|
NDC 60432009216
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.51 |
| Max. Negotiated Rate |
$400.16 |
| Rate for Payer: Aetna American Axle |
$289.00
|
| Rate for Payer: Aetna Commercial |
$377.93
|
| Rate for Payer: Aetna Medicare |
$222.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.00
|
| Rate for Payer: BCBS Complete |
$177.85
|
| Rate for Payer: Cash Price |
$355.70
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Commercial |
$382.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$311.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.70
|
| Rate for Payer: Healthscope Commercial |
$400.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$311.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.93
|
| Rate for Payer: PHP Commercial |
$377.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.00
|
| Rate for Payer: Priority Health SBD |
$280.11
|
| Rate for Payer: UMR Bronson Commercial |
$164.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.46
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$311.24
|
|
|
Service Code
|
NDC 54838051080
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna American Axle |
$202.31
|
| Rate for Payer: Aetna Commercial |
$264.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.31
|
| Rate for Payer: Cash Price |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$267.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.99
|
| Rate for Payer: Healthscope Commercial |
$280.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.55
|
| Rate for Payer: PHP Commercial |
$264.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.31
|
| Rate for Payer: Priority Health SBD |
$196.08
|
| Rate for Payer: UMR Bronson Commercial |
$136.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.43
|
|
|
OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$311.24
|
|
|
Service Code
|
NDC 54838051080
|
| Hospital Charge Code |
10810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.16 |
| Max. Negotiated Rate |
$280.12 |
| Rate for Payer: Aetna American Axle |
$202.31
|
| Rate for Payer: Aetna Commercial |
$264.55
|
| Rate for Payer: Aetna Medicare |
$155.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.31
|
| Rate for Payer: BCBS Complete |
$124.50
|
| Rate for Payer: Cash Price |
$248.99
|
| Rate for Payer: Cofinity Commercial |
$217.87
|
| Rate for Payer: Cofinity Commercial |
$267.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.99
|
| Rate for Payer: Healthscope Commercial |
$280.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.55
|
| Rate for Payer: PHP Commercial |
$264.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.31
|
| Rate for Payer: Priority Health SBD |
$196.08
|
| Rate for Payer: UMR Bronson Commercial |
$115.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.43
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$131.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 68084040011
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$131.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
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 |
$196.36
|
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna Medicare |
$151.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| 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 |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| 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 |
$226.58
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna Medicare |
$162.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: BCBS Complete |
$130.34
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$120.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
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 |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| 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 |
$167.08
|
| 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
|
$3.03
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$274.55
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna American Axle |
$178.46
|
| Rate for Payer: Aetna Commercial |
$233.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.46
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Cofinity Commercial |
$236.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.64
|
| Rate for Payer: Healthscope Commercial |
$247.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.37
|
| Rate for Payer: PHP Commercial |
$233.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.46
|
| Rate for Payer: Priority Health SBD |
$172.97
|
| Rate for Payer: UMR Bronson Commercial |
$120.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.91
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$274.55
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.58 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna American Axle |
$178.46
|
| Rate for Payer: Aetna Commercial |
$233.37
|
| Rate for Payer: Aetna Medicare |
$137.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.46
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Cofinity Commercial |
$236.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.64
|
| Rate for Payer: Healthscope Commercial |
$247.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.37
|
| Rate for Payer: PHP Commercial |
$233.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.46
|
| Rate for Payer: Priority Health SBD |
$172.97
|
| Rate for Payer: UMR Bronson Commercial |
$101.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.91
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.37 |
| Max. Negotiated Rate |
$293.26 |
| Rate for Payer: Aetna American Axle |
$211.80
|
| Rate for Payer: Aetna Commercial |
$276.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.80
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$280.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$293.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: PHP Commercial |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health SBD |
$205.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.39
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.92 |
| Max. Negotiated Rate |
$271.89 |
| Rate for Payer: Aetna American Axle |
$196.36
|
| Rate for Payer: Aetna Commercial |
$256.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| 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 |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.78
|
| Rate for Payer: PHP Commercial |
$256.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| Rate for Payer: Priority Health SBD |
$190.32
|
| Rate for Payer: UMR Bronson Commercial |
$132.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.58
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040011
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00832003800
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| 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 |
$167.08
|
| 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 |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
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: Cofinity Commercial |
$221.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.03
|
| Rate for Payer: Aetna American Axle |
$167.17
|
| Rate for Payer: Aetna Commercial |
$218.61
|
| Rate for Payer: Aetna Medicare |
$128.60
|
| 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: 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 |
$362.28
|
| 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
|
$8.43
|
|
|
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
|
|
