|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$393.75
|
|
|
Service Code
|
NDC 42858010401
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.69 |
| Max. Negotiated Rate |
$354.38 |
| Rate for Payer: Aetna American Axle |
$255.94
|
| Rate for Payer: Aetna Commercial |
$334.69
|
| Rate for Payer: Aetna Medicare |
$196.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.94
|
| Rate for Payer: BCBS Complete |
$157.50
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$275.62
|
| Rate for Payer: Cofinity Commercial |
$338.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.00
|
| Rate for Payer: Healthscope Commercial |
$354.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.69
|
| Rate for Payer: PHP Commercial |
$334.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.94
|
| Rate for Payer: Priority Health SBD |
$248.06
|
| Rate for Payer: UMR Bronson Commercial |
$145.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.31
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$12.19
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna American Axle |
$7.92
|
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.75
|
| Rate for Payer: Healthscope Commercial |
$10.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.36
|
| Rate for Payer: PHP Commercial |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health SBD |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$5.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.14
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$5.56
|
|
|
Service Code
|
NDC 50268064611
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.61
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$393.75
|
|
|
Service Code
|
NDC 42858010401
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.25 |
| Max. Negotiated Rate |
$354.38 |
| Rate for Payer: Aetna American Axle |
$255.94
|
| Rate for Payer: Aetna Commercial |
$334.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.94
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cofinity Commercial |
$275.62
|
| Rate for Payer: Cofinity Commercial |
$338.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$275.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.00
|
| Rate for Payer: Healthscope Commercial |
$354.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$275.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.69
|
| Rate for Payer: PHP Commercial |
$334.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.94
|
| Rate for Payer: Priority Health SBD |
$248.06
|
| Rate for Payer: UMR Bronson Commercial |
$173.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.31
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$327.25
|
|
|
Service Code
|
NDC 13107004601
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.08 |
| Max. Negotiated Rate |
$294.52 |
| Rate for Payer: Aetna American Axle |
$212.71
|
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare |
$163.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.71
|
| Rate for Payer: BCBS Complete |
$130.90
|
| Rate for Payer: Cash Price |
$261.80
|
| Rate for Payer: Cofinity Commercial |
$229.08
|
| Rate for Payer: Cofinity Commercial |
$281.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.80
|
| Rate for Payer: Healthscope Commercial |
$294.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.16
|
| Rate for Payer: PHP Commercial |
$278.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.71
|
| Rate for Payer: Priority Health SBD |
$206.17
|
| Rate for Payer: UMR Bronson Commercial |
$121.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.44
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$12.19
|
|
|
Service Code
|
NDC 00406052323
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$10.97 |
| Rate for Payer: Aetna American Axle |
$7.92
|
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Cofinity Commercial |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$8.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.75
|
| Rate for Payer: Healthscope Commercial |
$10.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.36
|
| Rate for Payer: PHP Commercial |
$10.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.92
|
| Rate for Payer: Priority Health SBD |
$7.68
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.14
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$277.55
|
|
|
Service Code
|
NDC 50268064615
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.69 |
| Max. Negotiated Rate |
$249.80 |
| Rate for Payer: Aetna American Axle |
$180.41
|
| Rate for Payer: Aetna Commercial |
$235.92
|
| Rate for Payer: Aetna Medicare |
$138.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.41
|
| Rate for Payer: BCBS Complete |
$111.02
|
| Rate for Payer: Cash Price |
$222.04
|
| Rate for Payer: Cofinity Commercial |
$194.28
|
| Rate for Payer: Cofinity Commercial |
$238.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.04
|
| Rate for Payer: Healthscope Commercial |
$249.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.92
|
| Rate for Payer: PHP Commercial |
$235.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.41
|
| Rate for Payer: Priority Health SBD |
$174.86
|
| Rate for Payer: UMR Bronson Commercial |
$102.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.16
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$5.56
|
|
|
Service Code
|
NDC 50268064611
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Aetna American Axle |
$3.61
|
| Rate for Payer: Aetna Commercial |
$4.73
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.61
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: Cash Price |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.45
|
| Rate for Payer: Healthscope Commercial |
$5.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.73
|
| Rate for Payer: PHP Commercial |
$4.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.61
|
| Rate for Payer: Priority Health SBD |
$3.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.17
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
NDC 60687064211
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna American Axle |
$4.20
|
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.20
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cofinity Commercial |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.49
|
| Rate for Payer: PHP Commercial |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: Priority Health SBD |
$4.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.84
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$290.50
|
|
|
Service Code
|
NDC 00406051201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: Cash Price |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.40
|
| Rate for Payer: Healthscope Commercial |
$261.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.92
|
| Rate for Payer: PHP Commercial |
$246.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.82
|
| Rate for Payer: Priority Health SBD |
$183.02
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$645.75
|
|
|
Service Code
|
NDC 60687064201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.13 |
| Max. Negotiated Rate |
$581.18 |
| Rate for Payer: Aetna American Axle |
$419.74
|
| Rate for Payer: Aetna Commercial |
$548.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.74
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cofinity Commercial |
$452.02
|
| Rate for Payer: Cofinity Commercial |
$555.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$452.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.60
|
| Rate for Payer: Healthscope Commercial |
$581.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.89
|
| Rate for Payer: PHP Commercial |
$548.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.74
|
| Rate for Payer: Priority Health SBD |
$406.82
|
| Rate for Payer: UMR Bronson Commercial |
$284.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.31
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$65.28
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: UMR Bronson Commercial |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$65.28
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$58.75 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.49
|
| Rate for Payer: Aetna Medicare |
$32.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$45.70
|
| Rate for Payer: Cofinity Commercial |
$56.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.49
|
| Rate for Payer: PHP Commercial |
$55.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.43
|
| Rate for Payer: Priority Health SBD |
$41.13
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.96
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
NDC 60687064211
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna American Axle |
$4.20
|
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.20
|
| Rate for Payer: BCBS Complete |
$2.58
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cofinity Commercial |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.49
|
| Rate for Payer: PHP Commercial |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: Priority Health SBD |
$4.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.84
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$290.50
|
|
|
Service Code
|
NDC 00406051201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$261.45 |
| Rate for Payer: Aetna American Axle |
$188.82
|
| Rate for Payer: Aetna Commercial |
$246.92
|
| Rate for Payer: Aetna Medicare |
$145.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.82
|
| Rate for Payer: BCBS Complete |
$116.20
|
| Rate for Payer: Cash Price |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$203.35
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.40
|
| Rate for Payer: Healthscope Commercial |
$261.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$217.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.92
|
| Rate for Payer: PHP Commercial |
$246.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.82
|
| Rate for Payer: Priority Health SBD |
$183.02
|
| Rate for Payer: UMR Bronson Commercial |
$107.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$217.88
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$645.75
|
|
|
Service Code
|
NDC 60687064201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.93 |
| Max. Negotiated Rate |
$581.18 |
| Rate for Payer: Aetna American Axle |
$419.74
|
| Rate for Payer: Aetna Commercial |
$548.89
|
| Rate for Payer: Aetna Medicare |
$322.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.74
|
| Rate for Payer: BCBS Complete |
$258.30
|
| Rate for Payer: Cash Price |
$516.60
|
| Rate for Payer: Cofinity Commercial |
$452.02
|
| Rate for Payer: Cofinity Commercial |
$555.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$452.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$516.60
|
| Rate for Payer: Healthscope Commercial |
$581.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$452.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$484.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.89
|
| Rate for Payer: PHP Commercial |
$548.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.74
|
| Rate for Payer: Priority Health SBD |
$406.82
|
| Rate for Payer: UMR Bronson Commercial |
$238.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$484.31
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,452.50
|
|
|
Service Code
|
NDC 00406051205
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$639.10 |
| Max. Negotiated Rate |
$1,307.25 |
| Rate for Payer: Aetna American Axle |
$944.12
|
| Rate for Payer: Aetna Commercial |
$1,234.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.12
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cofinity Commercial |
$1,016.75
|
| Rate for Payer: Cofinity Commercial |
$1,249.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,016.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.00
|
| Rate for Payer: Healthscope Commercial |
$1,307.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,016.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,234.62
|
| Rate for Payer: PHP Commercial |
$1,234.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.12
|
| Rate for Payer: Priority Health SBD |
$915.08
|
| Rate for Payer: UMR Bronson Commercial |
$639.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.38
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
IP
|
$269.50
|
|
|
Service Code
|
NDC 42858010201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna American Axle |
$175.18
|
| Rate for Payer: Aetna Commercial |
$229.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.18
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$188.65
|
| Rate for Payer: Cofinity Commercial |
$231.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.60
|
| Rate for Payer: Healthscope Commercial |
$242.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.08
|
| Rate for Payer: PHP Commercial |
$229.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.18
|
| Rate for Payer: Priority Health SBD |
$169.78
|
| Rate for Payer: UMR Bronson Commercial |
$118.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.12
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$269.50
|
|
|
Service Code
|
NDC 42858010201
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.72 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna American Axle |
$175.18
|
| Rate for Payer: Aetna Commercial |
$229.08
|
| Rate for Payer: Aetna Medicare |
$134.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.18
|
| Rate for Payer: BCBS Complete |
$107.80
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$188.65
|
| Rate for Payer: Cofinity Commercial |
$231.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.60
|
| Rate for Payer: Healthscope Commercial |
$242.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.08
|
| Rate for Payer: PHP Commercial |
$229.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.18
|
| Rate for Payer: Priority Health SBD |
$169.78
|
| Rate for Payer: UMR Bronson Commercial |
$99.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.12
|
|
|
OXYCODONE-ACETAMINOPHEN 5 MG-325 MG TABLET
|
Facility
|
OP
|
$1,452.50
|
|
|
Service Code
|
NDC 00406051205
|
| Hospital Charge Code |
5940
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$537.42 |
| Max. Negotiated Rate |
$1,307.25 |
| Rate for Payer: Aetna American Axle |
$944.12
|
| Rate for Payer: Aetna Commercial |
$1,234.62
|
| Rate for Payer: Aetna Medicare |
$726.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.12
|
| Rate for Payer: BCBS Complete |
$581.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cofinity Commercial |
$1,016.75
|
| Rate for Payer: Cofinity Commercial |
$1,249.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,016.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,162.00
|
| Rate for Payer: Healthscope Commercial |
$1,307.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,016.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,089.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,234.62
|
| Rate for Payer: PHP Commercial |
$1,234.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$944.12
|
| Rate for Payer: Priority Health SBD |
$915.08
|
| Rate for Payer: UMR Bronson Commercial |
$537.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,089.38
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$10.36
|
|
|
Service Code
|
NDC 50268064511
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna American Axle |
$6.73
|
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.73
|
| Rate for Payer: BCBS Complete |
$4.14
|
| Rate for Payer: Cash Price |
$8.29
|
| Rate for Payer: Cofinity Commercial |
$7.25
|
| Rate for Payer: Cofinity Commercial |
$8.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.29
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.81
|
| Rate for Payer: PHP Commercial |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.73
|
| Rate for Payer: Priority Health SBD |
$6.53
|
| Rate for Payer: UMR Bronson Commercial |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.77
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$9,685.17
|
|
|
Service Code
|
NDC 63481062870
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,261.47 |
| Max. Negotiated Rate |
$8,716.65 |
| Rate for Payer: Aetna American Axle |
$6,295.36
|
| Rate for Payer: Aetna Commercial |
$8,232.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,295.36
|
| Rate for Payer: Cash Price |
$7,748.14
|
| Rate for Payer: Cofinity Commercial |
$6,779.62
|
| Rate for Payer: Cofinity Commercial |
$8,329.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,779.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,748.14
|
| Rate for Payer: Healthscope Commercial |
$8,716.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,779.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,263.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,232.39
|
| Rate for Payer: PHP Commercial |
$8,232.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,295.36
|
| Rate for Payer: Priority Health SBD |
$6,101.66
|
| Rate for Payer: UMR Bronson Commercial |
$4,261.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,263.88
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$9,685.17
|
|
|
Service Code
|
NDC 63481062870
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,583.51 |
| Max. Negotiated Rate |
$8,716.65 |
| Rate for Payer: Aetna American Axle |
$6,295.36
|
| Rate for Payer: Aetna Commercial |
$8,232.39
|
| Rate for Payer: Aetna Medicare |
$4,842.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,295.36
|
| Rate for Payer: BCBS Complete |
$3,874.07
|
| Rate for Payer: Cash Price |
$7,748.14
|
| Rate for Payer: Cofinity Commercial |
$6,779.62
|
| Rate for Payer: Cofinity Commercial |
$8,329.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,779.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,748.14
|
| Rate for Payer: Healthscope Commercial |
$8,716.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,779.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,263.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,232.39
|
| Rate for Payer: PHP Commercial |
$8,232.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,295.36
|
| Rate for Payer: Priority Health SBD |
$6,101.66
|
| Rate for Payer: UMR Bronson Commercial |
$3,583.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,263.88
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 47781022901
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.82 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.58
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.58
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.58
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UMR Bronson Commercial |
$204.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 47781022901
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna American Axle |
$302.58
|
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$232.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.58
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$325.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.58
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UMR Bronson Commercial |
$172.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.12
|
|
