|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$4,136.88
|
|
|
Service Code
|
NDC 00093573401
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,820.23 |
| Max. Negotiated Rate |
$3,723.19 |
| Rate for Payer: Aetna American Axle |
$2,688.97
|
| Rate for Payer: Aetna Commercial |
$3,516.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.97
|
| Rate for Payer: Cash Price |
$3,309.50
|
| Rate for Payer: Cofinity Commercial |
$2,895.82
|
| Rate for Payer: Cofinity Commercial |
$3,557.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,895.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,309.50
|
| Rate for Payer: Healthscope Commercial |
$3,723.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,895.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,102.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,516.35
|
| Rate for Payer: PHP Commercial |
$3,516.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,688.97
|
| Rate for Payer: Priority Health SBD |
$2,606.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,820.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,102.66
|
|
|
OXYCODONE ER 80 MG TABLET,CRUSH RESISTANT,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,534.17
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
173657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$675.03 |
| Max. Negotiated Rate |
$1,380.75 |
| Rate for Payer: Aetna American Axle |
$997.21
|
| Rate for Payer: Aetna Commercial |
$1,304.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.21
|
| Rate for Payer: Cash Price |
$1,227.34
|
| Rate for Payer: Cofinity Commercial |
$1,073.92
|
| Rate for Payer: Cofinity Commercial |
$1,319.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,073.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.34
|
| Rate for Payer: Healthscope Commercial |
$1,380.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,150.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,304.04
|
| Rate for Payer: PHP Commercial |
$1,304.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$997.21
|
| Rate for Payer: Priority Health SBD |
$966.53
|
| Rate for Payer: UMR Bronson Commercial |
$675.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,150.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
OP
|
$26.88
|
|
|
Service Code
|
NDC 41100001511
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna American Axle |
$17.47
|
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.47
|
| Rate for Payer: BCBS Complete |
$10.75
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| Rate for Payer: UMR Bronson Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.16
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
NDC 23900002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna American Axle |
$21.12
|
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health SBD |
$20.48
|
| Rate for Payer: UMR Bronson Commercial |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
IP
|
$26.88
|
|
|
Service Code
|
NDC 41100001511
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.83 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna American Axle |
$17.47
|
| Rate for Payer: Aetna Commercial |
$22.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.47
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Commercial |
$23.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.50
|
| Rate for Payer: Healthscope Commercial |
$24.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.85
|
| Rate for Payer: PHP Commercial |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.47
|
| Rate for Payer: Priority Health SBD |
$16.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.16
|
|
|
OXYMETAZOLINE 0.05 % NASAL MIST
|
Facility
|
OP
|
$32.50
|
|
|
Service Code
|
NDC 23900002325
|
| Hospital Charge Code |
112974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna American Axle |
$21.12
|
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna Medicare |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.12
|
| Rate for Payer: BCBS Complete |
$13.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.12
|
| Rate for Payer: Priority Health SBD |
$20.48
|
| Rate for Payer: UMR Bronson Commercial |
$12.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna American Axle |
$26.69
|
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.69
|
| Rate for Payer: BCBS Complete |
$16.42
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$28.74
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.69
|
| Rate for Payer: Priority Health SBD |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$15.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 45802041059
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.60
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Medicare |
$13.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: BCBS Complete |
$10.86
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$10.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$6.57
|
|
|
Service Code
|
NDC 59390003613
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: BCBS Complete |
$2.63
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$16.20
|
|
|
Service Code
|
NDC 70000000101
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$14.58 |
| Rate for Payer: Aetna American Axle |
$10.53
|
| Rate for Payer: Aetna Commercial |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: Cash Price |
$12.96
|
| Rate for Payer: Cofinity Commercial |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.96
|
| Rate for Payer: Healthscope Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.77
|
| Rate for Payer: PHP Commercial |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.53
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.15
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$41.06
|
|
|
Service Code
|
NDC 41100081125
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$36.95 |
| Rate for Payer: Aetna American Axle |
$26.69
|
| Rate for Payer: Aetna Commercial |
$34.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.69
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cofinity Commercial |
$28.74
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.85
|
| Rate for Payer: Healthscope Commercial |
$36.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.90
|
| Rate for Payer: PHP Commercial |
$34.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.69
|
| Rate for Payer: Priority Health SBD |
$25.87
|
| Rate for Payer: UMR Bronson Commercial |
$18.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.80
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$9.94
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$27.15
|
|
|
Service Code
|
NDC 41100081123
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.08
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.65
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 00904676130
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna American Axle |
$6.14
|
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 59390003613
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna American Axle |
$4.27
|
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.26
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.58
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.27
|
| Rate for Payer: Priority Health SBD |
$4.14
|
| Rate for Payer: UMR Bronson Commercial |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.93
|
|
|
OXYMETAZOLINE 0.05 % NASAL SPRAY
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 23900001252
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna American Axle |
$16.15
|
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$17.39
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.15
|
| Rate for Payer: Priority Health SBD |
$15.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
OXYMORPHONE 10 MG TABLET
|
Facility
|
OP
|
$758.88
|
|
|
Service Code
|
NDC 31722093001
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna Medicare |
$379.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: BCBS Complete |
$303.55
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.05
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.27
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$280.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
|
OXYMORPHONE 10 MG TABLET
|
Facility
|
IP
|
$758.88
|
|
|
Service Code
|
NDC 31722093001
|
| Hospital Charge Code |
76676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.91 |
| Max. Negotiated Rate |
$682.99 |
| Rate for Payer: Aetna American Axle |
$493.27
|
| Rate for Payer: Aetna Commercial |
$645.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$493.27
|
| Rate for Payer: Cash Price |
$607.10
|
| Rate for Payer: Cofinity Commercial |
$531.22
|
| Rate for Payer: Cofinity Commercial |
$652.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$531.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$682.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$531.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$569.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.05
|
| Rate for Payer: PHP Commercial |
$645.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.27
|
| Rate for Payer: Priority Health SBD |
$478.09
|
| Rate for Payer: UMR Bronson Commercial |
$333.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$569.16
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.78
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$22.30 |
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna American Axle |
$473.32
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$509.73
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Healthscope Commercial |
$132.52
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.32
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: UMR Bronson Commercial |
$320.40
|
| Rate for Payer: UMR Bronson Commercial |
$10.90
|
| Rate for Payer: UMR Bronson Commercial |
$64.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.58
|
|
|
OXYTOCIN 10 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$728.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$655.37 |
| Rate for Payer: Aetna American Axle |
$473.32
|
| Rate for Payer: Aetna American Axle |
$16.11
|
| Rate for Payer: Aetna American Axle |
$95.71
|
| Rate for Payer: Aetna Commercial |
$618.96
|
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Commercial |
$21.06
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$73.62
|
| Rate for Payer: Aetna Medicare |
$364.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Complete |
$291.28
|
| Rate for Payer: BCBS Complete |
$58.90
|
| Rate for Payer: BCBS Trust/PPO |
$5.11
|
| Rate for Payer: BCBS Trust/PPO |
$5.11
|
| Rate for Payer: BCBS Trust/PPO |
$5.11
|
| Rate for Payer: BCN Commercial |
$5.11
|
| Rate for Payer: BCN Commercial |
$5.11
|
| Rate for Payer: BCN Commercial |
$5.11
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$117.80
|
| Rate for Payer: Cash Price |
$582.55
|
| Rate for Payer: Cofinity Commercial |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$103.08
|
| Rate for Payer: Cofinity Commercial |
$126.64
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$509.73
|
| Rate for Payer: Cofinity Commercial |
$626.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$509.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$582.55
|
| Rate for Payer: Healthscope Commercial |
$655.37
|
| Rate for Payer: Healthscope Commercial |
$22.30
|
| Rate for Payer: Healthscope Commercial |
$132.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$509.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$618.96
|
| Rate for Payer: PHP Commercial |
$125.16
|
| Rate for Payer: PHP Commercial |
$21.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.32
|
| Rate for Payer: Priority Health SBD |
$15.61
|
| Rate for Payer: Priority Health SBD |
$458.76
|
| Rate for Payer: Priority Health SBD |
$92.77
|
| Rate for Payer: UMR Bronson Commercial |
$269.43
|
| Rate for Payer: UMR Bronson Commercial |
$54.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.14
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
OP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna Medicare |
$33.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: BCBS Complete |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$5.11
|
| Rate for Payer: BCN Commercial |
$5.11
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
|
OXYTOCIN 30 UNIT/500 ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS
|
Facility
|
IP
|
$67.19
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
115673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna American Axle |
$43.67
|
| Rate for Payer: Aetna Commercial |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.67
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$47.03
|
| Rate for Payer: Cofinity Commercial |
$57.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.75
|
| Rate for Payer: Healthscope Commercial |
$60.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.11
|
| Rate for Payer: PHP Commercial |
$57.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health SBD |
$42.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.39
|
|
