|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$462.00
|
|
|
Service Code
|
NDC 47781026501
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.94 |
| Max. Negotiated Rate |
$415.80 |
| Rate for Payer: Aetna American Axle |
$300.30
|
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Aetna Medicare |
$231.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.30
|
| Rate for Payer: BCBS Complete |
$184.80
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$323.40
|
| Rate for Payer: Cofinity Commercial |
$397.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$369.60
|
| Rate for Payer: Healthscope Commercial |
$415.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.70
|
| Rate for Payer: PHP Commercial |
$392.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.30
|
| Rate for Payer: Priority Health SBD |
$291.06
|
| Rate for Payer: UMR Bronson Commercial |
$170.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.50
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$864.50
|
|
|
Service Code
|
NDC 10702000901
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.38 |
| Max. Negotiated Rate |
$778.05 |
| Rate for Payer: Cofinity Commercial |
$605.15
|
| Rate for Payer: Cofinity Commercial |
$743.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.15
|
| Rate for Payer: Aetna American Axle |
$561.92
|
| Rate for Payer: Aetna Commercial |
$734.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.92
|
| Rate for Payer: Cash Price |
$691.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.60
|
| Rate for Payer: Healthscope Commercial |
$778.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$605.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.82
|
| Rate for Payer: PHP Commercial |
$734.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.92
|
| Rate for Payer: Priority Health SBD |
$544.64
|
| Rate for Payer: UMR Bronson Commercial |
$380.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.38
|
|
|
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 |
$656.78 |
| 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 |
$627.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.80
|
| Rate for Payer: Healthscope Commercial |
$656.78
|
| 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
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 00406853001
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.43 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cofinity Commercial |
$562.28
|
| Rate for Payer: Cofinity Commercial |
$690.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$562.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.60
|
| Rate for Payer: Healthscope Commercial |
$722.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.76
|
| Rate for Payer: PHP Commercial |
$682.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$522.11
|
| Rate for Payer: Priority Health SBD |
$506.05
|
| Rate for Payer: UMR Bronson Commercial |
$353.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.44
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$631.75
|
|
|
Service Code
|
NDC 57664022488
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.75 |
| Max. Negotiated Rate |
$568.58 |
| Rate for Payer: Aetna American Axle |
$410.64
|
| Rate for Payer: Aetna Commercial |
$536.99
|
| Rate for Payer: Aetna Medicare |
$315.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.64
|
| Rate for Payer: BCBS Complete |
$252.70
|
| Rate for Payer: Cash Price |
$505.40
|
| Rate for Payer: Cofinity Commercial |
$442.22
|
| Rate for Payer: Cofinity Commercial |
$543.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$442.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$505.40
|
| Rate for Payer: Healthscope Commercial |
$568.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$473.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.99
|
| Rate for Payer: PHP Commercial |
$536.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.64
|
| Rate for Payer: Priority Health SBD |
$398.00
|
| Rate for Payer: UMR Bronson Commercial |
$233.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$473.81
|
|
|
OXYCODONE 30 MG TABLET
|
Facility
|
OP
|
$729.75
|
|
|
Service Code
|
NDC 65162005110
|
| Hospital Charge Code |
28900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.01 |
| Max. Negotiated Rate |
$656.78 |
| Rate for Payer: Aetna American Axle |
$474.34
|
| Rate for Payer: Aetna Commercial |
$620.29
|
| Rate for Payer: Aetna Medicare |
$364.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.34
|
| Rate for Payer: BCBS Complete |
$291.90
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$510.82
|
| Rate for Payer: Cofinity Commercial |
$627.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.80
|
| Rate for Payer: Healthscope Commercial |
$656.78
|
| 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 |
$270.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.31
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
NDC 00121482705
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$27.86
|
|
|
Service Code
|
NDC 60687040640
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$10.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
NDC 00904682894
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna American Axle |
$15.40
|
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UMR Bronson Commercial |
$10.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.78
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$21.56
|
|
|
Service Code
|
NDC 60687040677
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.33
|
| Rate for Payer: Aetna Medicare |
$10.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.33
|
| Rate for Payer: PHP Commercial |
$18.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$7.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.17
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$25.31
|
|
|
Service Code
|
NDC 00904682805
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.14 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health SBD |
$15.95
|
| Rate for Payer: UMR Bronson Commercial |
$11.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$27.86
|
|
|
Service Code
|
NDC 60687040640
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna American Axle |
$18.11
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.11
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$19.50
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health SBD |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
NDC 00904682894
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna American Axle |
$15.40
|
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UMR Bronson Commercial |
$8.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.78
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$25.31
|
|
|
Service Code
|
NDC 00904682805
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna American Axle |
$16.45
|
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health SBD |
$15.95
|
| Rate for Payer: UMR Bronson Commercial |
$9.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$32.10
|
|
|
Service Code
|
NDC 00121482740
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: UMR Bronson Commercial |
$14.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$21.56
|
|
|
Service Code
|
NDC 60687040677
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.49 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Aetna American Axle |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.01
|
| Rate for Payer: Cash Price |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$18.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$19.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.33
|
| Rate for Payer: PHP Commercial |
$18.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.01
|
| Rate for Payer: Priority Health SBD |
$13.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.17
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
NDC 00121482705
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: UMR Bronson Commercial |
$11.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$647.50
|
|
|
Service Code
|
NDC 00904667840
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.58 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna American Axle |
$420.88
|
| Rate for Payer: Aetna Commercial |
$550.38
|
| Rate for Payer: Aetna Medicare |
$323.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.88
|
| Rate for Payer: BCBS Complete |
$259.00
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$453.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.00
|
| Rate for Payer: Healthscope Commercial |
$582.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.38
|
| Rate for Payer: PHP Commercial |
$550.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.88
|
| Rate for Payer: Priority Health SBD |
$407.92
|
| Rate for Payer: UMR Bronson Commercial |
$239.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.62
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$32.10
|
|
|
Service Code
|
NDC 00121482740
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna American Axle |
$20.86
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: Cash Price |
$25.68
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$27.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.68
|
| Rate for Payer: Healthscope Commercial |
$28.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.86
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: UMR Bronson Commercial |
$11.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.08
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$647.50
|
|
|
Service Code
|
NDC 00904667840
|
| Hospital Charge Code |
10813
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.90 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna American Axle |
$420.88
|
| Rate for Payer: Aetna Commercial |
$550.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.88
|
| Rate for Payer: Cash Price |
$518.00
|
| Rate for Payer: Cofinity Commercial |
$453.25
|
| Rate for Payer: Cofinity Commercial |
$556.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$453.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$518.00
|
| Rate for Payer: Healthscope Commercial |
$582.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$453.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$485.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.38
|
| Rate for Payer: PHP Commercial |
$550.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.88
|
| Rate for Payer: Priority Health SBD |
$407.92
|
| Rate for Payer: UMR Bronson Commercial |
$284.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$485.62
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$654.50
|
|
|
Service Code
|
NDC 68084035411
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.98 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Aetna American Axle |
$425.42
|
| Rate for Payer: Aetna Commercial |
$556.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.42
|
| Rate for Payer: Cash Price |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$562.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$458.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.60
|
| Rate for Payer: Healthscope Commercial |
$589.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$458.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.32
|
| Rate for Payer: PHP Commercial |
$556.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.42
|
| Rate for Payer: Priority Health SBD |
$412.34
|
| Rate for Payer: UMR Bronson Commercial |
$287.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.88
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 00406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.58
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.58
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.58
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UMR Bronson Commercial |
$143.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
NDC 47781026305
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.80 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna American Axle |
$546.00
|
| Rate for Payer: Aetna Commercial |
$714.00
|
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cofinity Commercial |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$722.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$588.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$672.00
|
| Rate for Payer: Healthscope Commercial |
$756.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$588.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$630.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$714.00
|
| Rate for Payer: PHP Commercial |
$714.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: Priority Health SBD |
$529.20
|
| Rate for Payer: UMR Bronson Commercial |
$310.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$630.00
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$201.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.46 |
| Max. Negotiated Rate |
$181.12 |
| Rate for Payer: Aetna American Axle |
$130.81
|
| Rate for Payer: Aetna Commercial |
$171.06
|
| Rate for Payer: Aetna Medicare |
$100.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.81
|
| Rate for Payer: BCBS Complete |
$80.50
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cofinity Commercial |
$140.88
|
| Rate for Payer: Cofinity Commercial |
$173.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.00
|
| Rate for Payer: Healthscope Commercial |
$181.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.06
|
| Rate for Payer: PHP Commercial |
$171.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.81
|
| Rate for Payer: Priority Health SBD |
$126.79
|
| Rate for Payer: UMR Bronson Commercial |
$74.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.94
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna American Axle |
$286.65
|
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$308.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health SBD |
$277.83
|
| Rate for Payer: UMR Bronson Commercial |
$194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
