|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$878.86
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.18 |
| Max. Negotiated Rate |
$790.97 |
| Rate for Payer: Aetna American Axle |
$571.26
|
| Rate for Payer: Aetna Commercial |
$747.03
|
| Rate for Payer: Aetna Medicare |
$439.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.26
|
| Rate for Payer: BCBS Complete |
$351.54
|
| Rate for Payer: Cash Price |
$703.09
|
| Rate for Payer: Cofinity Commercial |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$755.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$615.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$703.09
|
| Rate for Payer: Healthscope Commercial |
$790.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$615.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$659.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$747.03
|
| Rate for Payer: PHP Commercial |
$747.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.26
|
| Rate for Payer: Priority Health SBD |
$553.68
|
| Rate for Payer: UMR Bronson Commercial |
$325.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.14
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$1,534.17
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$567.64 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Aetna American Axle |
$997.21
|
| Rate for Payer: Aetna Commercial |
$1,304.04
|
| Rate for Payer: Aetna Medicare |
$767.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.21
|
| Rate for Payer: BCBS Complete |
$613.67
|
| Rate for Payer: Cash Price |
$1,227.34
|
| Rate for Payer: Cofinity Commercial |
$1,073.92
|
| Rate for Payer: Cofinity Commercial |
$1,319.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,073.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.34
|
| Rate for Payer: Healthscope Commercial |
$1,380.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,150.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.04
|
| Rate for Payer: PHP Commercial |
$1,304.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.21
|
| Rate for Payer: Priority Health SBD |
$966.53
|
| Rate for Payer: UMR Bronson Commercial |
$567.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,150.63
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,534.17
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$675.03 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Aetna American Axle |
$997.21
|
| Rate for Payer: Aetna Commercial |
$1,304.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.21
|
| Rate for Payer: Cash Price |
$1,227.34
|
| Rate for Payer: Cofinity Commercial |
$1,073.92
|
| Rate for Payer: Cofinity Commercial |
$1,319.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,073.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.34
|
| Rate for Payer: Healthscope Commercial |
$1,380.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,150.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.04
|
| Rate for Payer: PHP Commercial |
$1,304.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.21
|
| Rate for Payer: Priority Health SBD |
$966.53
|
| Rate for Payer: UMR Bronson Commercial |
$675.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,150.63
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$7,478.79
|
|
|
Service Code
|
NDC 59011048010
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,767.15 |
| Max. Negotiated Rate |
$6,730.91 |
| Rate for Payer: Aetna American Axle |
$4,861.21
|
| Rate for Payer: Aetna Commercial |
$6,356.97
|
| Rate for Payer: Aetna Medicare |
$3,739.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,861.21
|
| Rate for Payer: BCBS Complete |
$2,991.52
|
| Rate for Payer: Cash Price |
$5,983.03
|
| Rate for Payer: Cofinity Commercial |
$5,235.15
|
| Rate for Payer: Cofinity Commercial |
$6,431.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,235.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,983.03
|
| Rate for Payer: Healthscope Commercial |
$6,730.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,235.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,609.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,356.97
|
| Rate for Payer: PHP Commercial |
$6,356.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,861.21
|
| Rate for Payer: Priority Health SBD |
$4,711.64
|
| Rate for Payer: UMR Bronson Commercial |
$2,767.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,609.09
|
|
|
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 Commercial |
$2,895.82
|
| Rate for Payer: Cofinity Commercial |
$3,557.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,895.82
|
| 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: PHP Commercial |
$3,516.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.97
|
| Rate for Payer: Priority Health SBD |
$2,606.23
|
| 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
|
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 Commercial |
$2,895.82
|
| Rate for Payer: Cofinity Commercial |
$3,557.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,895.82
|
| 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: PHP Commercial |
$3,516.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.97
|
| 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
|
IP
|
$7,478.79
|
|
|
Service Code
|
NDC 59011048010
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,290.67 |
| Max. Negotiated Rate |
$6,730.91 |
| Rate for Payer: Aetna American Axle |
$4,861.21
|
| Rate for Payer: Aetna Commercial |
$6,356.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,861.21
|
| Rate for Payer: Cash Price |
$5,983.03
|
| Rate for Payer: Cofinity Commercial |
$5,235.15
|
| Rate for Payer: Cofinity Commercial |
$6,431.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,235.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,983.03
|
| Rate for Payer: Healthscope Commercial |
$6,730.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,235.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,609.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,356.97
|
| Rate for Payer: PHP Commercial |
$6,356.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,861.21
|
| Rate for Payer: Priority Health SBD |
$4,711.64
|
| Rate for Payer: UMR Bronson Commercial |
$3,290.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,609.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
NDC 23900002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna American Axle |
$21.12
|
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health SBD |
$20.48
|
| Rate for Payer: UMR Bronson Commercial |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
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 Commercial |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.82
|
| 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: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| 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
|
OP
|
$32.50
|
|
|
Service Code
|
NDC 23900002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.03 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna American Axle |
$21.12
|
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna Medicare |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: BCBS Complete |
$13.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health SBD |
$20.48
|
| Rate for Payer: UMR Bronson Commercial |
$12.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
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 Commercial |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.82
|
| 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: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| 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 SPRAY
|
Facility
|
OP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Medicare |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
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 Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| 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: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| 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
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
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 Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| 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: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| 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
|
IP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna American Axle |
$26.69
|
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.69
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$28.74
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.69
|
| Rate for Payer: Priority Health SBD |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| 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: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| 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: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna American Axle |
$26.69
|
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.69
|
| Rate for Payer: BCBS Complete |
$16.42
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$28.74
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.69
|
| Rate for Payer: Priority Health SBD |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$15.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 70000000101
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 59390003613
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.43 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
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 Commercial |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYMORPHONE 10 MG TABLET
|
Facility
|
IP
|
$758.88
|
|
|
Service Code
|
NDC 31722093001
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.05
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.27
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$333.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
