|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$10.32
|
|
|
Service Code
|
NDC 00406052223
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.77
|
| Rate for Payer: PHP Commercial |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health SBD |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.74
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$10.36
|
|
|
Service Code
|
NDC 50268064511
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna American Axle |
$6.73
|
| Rate for Payer: Aetna Commercial |
$8.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.73
|
| 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 |
$4.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.77
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$10.32
|
|
|
Service Code
|
NDC 00406052223
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.77
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.22
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.77
|
| Rate for Payer: PHP Commercial |
$8.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health SBD |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.74
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$803.25
|
|
|
Service Code
|
NDC 00406052201
|
| Hospital Charge Code |
31863
|
|
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-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$803.25
|
|
|
Service Code
|
NDC 00406052201
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$722.92 |
| Rate for Payer: Aetna American Axle |
$522.11
|
| Rate for Payer: Aetna Commercial |
$682.76
|
| Rate for Payer: Aetna Medicare |
$401.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.11
|
| Rate for Payer: BCBS Complete |
$321.30
|
| 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 |
$297.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.44
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
OP
|
$1,031.10
|
|
|
Service Code
|
NDC 00406052262
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.51 |
| Max. Negotiated Rate |
$927.99 |
| Rate for Payer: Aetna American Axle |
$670.22
|
| Rate for Payer: Aetna Commercial |
$876.44
|
| Rate for Payer: Aetna Medicare |
$515.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.22
|
| Rate for Payer: BCBS Complete |
$412.44
|
| Rate for Payer: Cash Price |
$824.88
|
| Rate for Payer: Cofinity Commercial |
$721.77
|
| Rate for Payer: Cofinity Commercial |
$886.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$721.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.88
|
| Rate for Payer: Healthscope Commercial |
$927.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$721.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.44
|
| Rate for Payer: PHP Commercial |
$876.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.22
|
| Rate for Payer: Priority Health SBD |
$649.59
|
| Rate for Payer: UMR Bronson Commercial |
$381.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.32
|
|
|
OXYCODONE-ACETAMINOPHEN 7.5 MG-325 MG TABLET
|
Facility
|
IP
|
$1,031.10
|
|
|
Service Code
|
NDC 00406052262
|
| Hospital Charge Code |
31863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$453.68 |
| Max. Negotiated Rate |
$927.99 |
| Rate for Payer: Aetna American Axle |
$670.22
|
| Rate for Payer: Aetna Commercial |
$876.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.22
|
| Rate for Payer: Cash Price |
$824.88
|
| Rate for Payer: Cofinity Commercial |
$721.77
|
| Rate for Payer: Cofinity Commercial |
$886.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$721.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$824.88
|
| Rate for Payer: Healthscope Commercial |
$927.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$721.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$773.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.44
|
| Rate for Payer: PHP Commercial |
$876.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.22
|
| Rate for Payer: Priority Health SBD |
$649.59
|
| Rate for Payer: UMR Bronson Commercial |
$453.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$773.32
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$877.11
|
|
|
Service Code
|
NDC 00093573101
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$385.93 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna American Axle |
$570.12
|
| Rate for Payer: Aetna Commercial |
$745.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.12
|
| Rate for Payer: Cash Price |
$701.69
|
| Rate for Payer: Cofinity Commercial |
$613.98
|
| Rate for Payer: Cofinity Commercial |
$754.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.69
|
| Rate for Payer: Healthscope Commercial |
$789.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.54
|
| Rate for Payer: PHP Commercial |
$745.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.12
|
| Rate for Payer: Priority Health SBD |
$552.58
|
| Rate for Payer: UMR Bronson Commercial |
$385.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.83
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$325.65
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.49 |
| Max. Negotiated Rate |
$293.08 |
| Rate for Payer: Aetna American Axle |
$211.67
|
| Rate for Payer: Aetna Commercial |
$276.80
|
| Rate for Payer: Aetna Medicare |
$162.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.67
|
| Rate for Payer: BCBS Complete |
$130.26
|
| Rate for Payer: Cash Price |
$260.52
|
| Rate for Payer: Cofinity Commercial |
$227.96
|
| Rate for Payer: Cofinity Commercial |
$280.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.52
|
| Rate for Payer: Healthscope Commercial |
$293.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.80
|
| Rate for Payer: PHP Commercial |
$276.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.67
|
| Rate for Payer: Priority Health SBD |
$205.16
|
| Rate for Payer: UMR Bronson Commercial |
$120.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.24
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$877.11
|
|
|
Service Code
|
NDC 00093573101
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$324.53 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna American Axle |
$570.12
|
| Rate for Payer: Aetna Commercial |
$745.54
|
| Rate for Payer: Aetna Medicare |
$438.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.12
|
| Rate for Payer: BCBS Complete |
$350.84
|
| Rate for Payer: Cash Price |
$701.69
|
| Rate for Payer: Cofinity Commercial |
$613.98
|
| Rate for Payer: Cofinity Commercial |
$754.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.69
|
| Rate for Payer: Healthscope Commercial |
$789.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$613.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.54
|
| Rate for Payer: PHP Commercial |
$745.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.12
|
| Rate for Payer: Priority Health SBD |
$552.58
|
| Rate for Payer: UMR Bronson Commercial |
$324.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.83
|
|
|
OXYCODONE ER 10 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$325.65
|
|
|
Service Code
|
NDC 59011041020
|
| Hospital Charge Code |
173651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.29 |
| Max. Negotiated Rate |
$293.08 |
| Rate for Payer: Aetna American Axle |
$211.67
|
| Rate for Payer: Aetna Commercial |
$276.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.67
|
| Rate for Payer: Cash Price |
$260.52
|
| Rate for Payer: Cofinity Commercial |
$227.96
|
| Rate for Payer: Cofinity Commercial |
$280.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.52
|
| Rate for Payer: Healthscope Commercial |
$293.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.80
|
| Rate for Payer: PHP Commercial |
$276.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.67
|
| Rate for Payer: Priority Health SBD |
$205.16
|
| Rate for Payer: UMR Bronson Commercial |
$143.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.24
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$2,334.54
|
|
|
Service Code
|
NDC 59011041510
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,027.20 |
| Max. Negotiated Rate |
$2,101.09 |
| Rate for Payer: Aetna American Axle |
$1,517.45
|
| Rate for Payer: Aetna Commercial |
$1,984.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,517.45
|
| Rate for Payer: Cash Price |
$1,867.63
|
| Rate for Payer: Cofinity Commercial |
$1,634.18
|
| Rate for Payer: Cofinity Commercial |
$2,007.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,634.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,867.63
|
| Rate for Payer: Healthscope Commercial |
$2,101.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,634.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,750.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,984.36
|
| Rate for Payer: PHP Commercial |
$1,984.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.45
|
| Rate for Payer: Priority Health SBD |
$1,470.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,027.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,750.90
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$405.38
|
|
|
Service Code
|
NDC 59011041520
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.37 |
| Max. Negotiated Rate |
$364.84 |
| Rate for Payer: Aetna American Axle |
$263.50
|
| Rate for Payer: Aetna Commercial |
$344.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.50
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cofinity Commercial |
$283.77
|
| Rate for Payer: Cofinity Commercial |
$348.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.30
|
| Rate for Payer: Healthscope Commercial |
$364.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.57
|
| Rate for Payer: PHP Commercial |
$344.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.50
|
| Rate for Payer: Priority Health SBD |
$255.39
|
| Rate for Payer: UMR Bronson Commercial |
$178.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.04
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$405.38
|
|
|
Service Code
|
NDC 59011041520
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.99 |
| Max. Negotiated Rate |
$364.84 |
| Rate for Payer: Aetna American Axle |
$263.50
|
| Rate for Payer: Aetna Commercial |
$344.57
|
| Rate for Payer: Aetna Medicare |
$202.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.50
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cofinity Commercial |
$283.77
|
| Rate for Payer: Cofinity Commercial |
$348.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.30
|
| Rate for Payer: Healthscope Commercial |
$364.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.57
|
| Rate for Payer: PHP Commercial |
$344.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.50
|
| Rate for Payer: Priority Health SBD |
$255.39
|
| Rate for Payer: UMR Bronson Commercial |
$149.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.04
|
|
|
OXYCODONE ER 15 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$2,334.54
|
|
|
Service Code
|
NDC 59011041510
|
| Hospital Charge Code |
173652
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$863.78 |
| Max. Negotiated Rate |
$2,101.09 |
| Rate for Payer: Aetna American Axle |
$1,517.45
|
| Rate for Payer: Aetna Commercial |
$1,984.36
|
| Rate for Payer: Aetna Medicare |
$1,167.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,517.45
|
| Rate for Payer: BCBS Complete |
$933.82
|
| Rate for Payer: Cash Price |
$1,867.63
|
| Rate for Payer: Cofinity Commercial |
$1,634.18
|
| Rate for Payer: Cofinity Commercial |
$2,007.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,634.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,867.63
|
| Rate for Payer: Healthscope Commercial |
$2,101.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,634.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,750.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,984.36
|
| Rate for Payer: PHP Commercial |
$1,984.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.45
|
| Rate for Payer: Priority Health SBD |
$1,470.76
|
| Rate for Payer: UMR Bronson Commercial |
$863.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,750.90
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$513.35
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.87 |
| Max. Negotiated Rate |
$462.02 |
| Rate for Payer: Aetna American Axle |
$333.68
|
| Rate for Payer: Aetna Commercial |
$436.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.68
|
| Rate for Payer: Cash Price |
$410.68
|
| Rate for Payer: Cofinity Commercial |
$359.34
|
| Rate for Payer: Cofinity Commercial |
$441.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.68
|
| Rate for Payer: Healthscope Commercial |
$462.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.35
|
| Rate for Payer: PHP Commercial |
$436.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.68
|
| Rate for Payer: Priority Health SBD |
$323.41
|
| Rate for Payer: UMR Bronson Commercial |
$225.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.01
|
|
|
OXYCODONE ER 20 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$513.35
|
|
|
Service Code
|
NDC 59011042020
|
| Hospital Charge Code |
173653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.94 |
| Max. Negotiated Rate |
$462.02 |
| Rate for Payer: Aetna American Axle |
$333.68
|
| Rate for Payer: Aetna Commercial |
$436.35
|
| Rate for Payer: Aetna Medicare |
$256.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.68
|
| Rate for Payer: BCBS Complete |
$205.34
|
| Rate for Payer: Cash Price |
$410.68
|
| Rate for Payer: Cofinity Commercial |
$359.34
|
| Rate for Payer: Cofinity Commercial |
$441.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$359.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$410.68
|
| Rate for Payer: Healthscope Commercial |
$462.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$359.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$385.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.35
|
| Rate for Payer: PHP Commercial |
$436.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.68
|
| Rate for Payer: Priority Health SBD |
$323.41
|
| Rate for Payer: UMR Bronson Commercial |
$189.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$385.01
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$4,286.04
|
|
|
Service Code
|
NDC 59011044010
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,585.83 |
| Max. Negotiated Rate |
$3,857.44 |
| Rate for Payer: Aetna American Axle |
$2,785.93
|
| Rate for Payer: Aetna Commercial |
$3,643.13
|
| Rate for Payer: Aetna Medicare |
$2,143.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,785.93
|
| Rate for Payer: BCBS Complete |
$1,714.42
|
| Rate for Payer: Cash Price |
$3,428.83
|
| Rate for Payer: Cofinity Commercial |
$3,000.23
|
| Rate for Payer: Cofinity Commercial |
$3,685.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,000.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,428.83
|
| Rate for Payer: Healthscope Commercial |
$3,857.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,000.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,214.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,643.13
|
| Rate for Payer: PHP Commercial |
$3,643.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.93
|
| Rate for Payer: Priority Health SBD |
$2,700.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,585.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,214.53
|
|
|
OXYCODONE ER 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$878.86
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$386.70 |
| Max. Negotiated Rate |
$790.97 |
| Rate for Payer: Aetna American Axle |
$571.26
|
| Rate for Payer: Aetna Commercial |
$747.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.26
|
| 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 |
$386.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$659.14
|
|
|
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 40 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$4,286.04
|
|
|
Service Code
|
NDC 59011044010
|
| Hospital Charge Code |
173655
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,885.86 |
| Max. Negotiated Rate |
$3,857.44 |
| Rate for Payer: Aetna American Axle |
$2,785.93
|
| Rate for Payer: Aetna Commercial |
$3,643.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,785.93
|
| Rate for Payer: Cash Price |
$3,428.83
|
| Rate for Payer: Cofinity Commercial |
$3,000.23
|
| Rate for Payer: Cofinity Commercial |
$3,685.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,000.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,428.83
|
| Rate for Payer: Healthscope Commercial |
$3,857.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,000.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,214.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,643.13
|
| Rate for Payer: PHP Commercial |
$3,643.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,785.93
|
| Rate for Payer: Priority Health SBD |
$2,700.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,885.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,214.53
|
|
|
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 |
$3,739.40
|
| 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
|
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
|
|
|
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
|
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 |
$767.08
|
| 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
|
|
