|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$408.50
|
|
|
Service Code
|
NDC 832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.15 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: Aetna Medicare |
$151.15
|
| Rate for Payer: ASR ASR |
$396.25
|
| Rate for Payer: BCBS Complete |
$163.40
|
| Rate for Payer: BCBS Trust/PPO |
$336.81
|
| Rate for Payer: BCN Commercial |
$336.81
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$396.25
|
| Rate for Payer: Healthscope Whirlpool |
$408.50
|
| Rate for Payer: Mclaren Commercial |
$367.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$357.93
|
| Rate for Payer: Priority Health Narrow Network |
$286.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$4.09
|
|
|
Service Code
|
NDC 832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Healthscope Whirlpool |
$4.08
|
| Rate for Payer: Mclaren Commercial |
$3.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$289.85
|
| Rate for Payer: Aetna Medicare |
$119.16
|
| Rate for Payer: ASR ASR |
$312.39
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: BCBS Trust/PPO |
$265.53
|
| Rate for Payer: BCN Commercial |
$265.53
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$302.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$312.39
|
| Rate for Payer: Healthscope Whirlpool |
$322.05
|
| Rate for Payer: Mclaren Commercial |
$289.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.18
|
| Rate for Payer: Priority Health Narrow Network |
$225.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.40
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$408.50
|
|
|
Service Code
|
NDC 832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.38 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: ASR ASR |
$396.25
|
| Rate for Payer: BCBS Trust/PPO |
$335.46
|
| Rate for Payer: BCN Commercial |
$335.46
|
| Rate for Payer: Cash Price |
$326.80
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.80
|
| Rate for Payer: Healthscope Commercial |
$396.25
|
| Rate for Payer: Healthscope Whirlpool |
$408.50
|
| Rate for Payer: Mclaren Commercial |
$367.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.23
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.48
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$4.09
|
|
|
Service Code
|
NDC 832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: ASR ASR |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$3.96
|
| Rate for Payer: Healthscope Whirlpool |
$4.08
|
| Rate for Payer: Mclaren Commercial |
$3.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.47
|
| Rate for Payer: Nomi Health Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.59
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.54 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$289.85
|
| Rate for Payer: ASR ASR |
$312.39
|
| Rate for Payer: BCBS Trust/PPO |
$264.47
|
| Rate for Payer: BCN Commercial |
$264.47
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$302.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$312.39
|
| Rate for Payer: Healthscope Whirlpool |
$322.05
|
| Rate for Payer: Mclaren Commercial |
$289.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.40
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Medicare |
$69.56
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$155.01
|
| Rate for Payer: BCN Commercial |
$155.01
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.73
|
| Rate for Payer: Priority Health Narrow Network |
$131.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$679.68
|
|
|
Service Code
|
NDC 904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$679.68 |
| Rate for Payer: Aetna Commercial |
$611.71
|
| Rate for Payer: Aetna Medicare |
$251.48
|
| Rate for Payer: ASR ASR |
$659.29
|
| Rate for Payer: BCBS Complete |
$271.87
|
| Rate for Payer: BCBS Trust/PPO |
$560.40
|
| Rate for Payer: BCN Commercial |
$560.40
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Commercial |
$638.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$659.29
|
| Rate for Payer: Healthscope Whirlpool |
$679.68
|
| Rate for Payer: Mclaren Commercial |
$611.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Nomi Health Commercial |
$557.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$595.54
|
| Rate for Payer: Priority Health Narrow Network |
$476.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.12
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$679.68
|
|
|
Service Code
|
NDC 904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$509.76 |
| Max. Negotiated Rate |
$679.68 |
| Rate for Payer: Aetna Commercial |
$611.71
|
| Rate for Payer: ASR ASR |
$659.29
|
| Rate for Payer: BCBS Trust/PPO |
$558.15
|
| Rate for Payer: BCN Commercial |
$558.15
|
| Rate for Payer: Cash Price |
$543.74
|
| Rate for Payer: Cofinity Commercial |
$638.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$543.74
|
| Rate for Payer: Healthscope Commercial |
$659.29
|
| Rate for Payer: Healthscope Whirlpool |
$679.68
|
| Rate for Payer: Mclaren Commercial |
$611.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$577.73
|
| Rate for Payer: Nomi Health Commercial |
$557.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$509.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$598.12
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: ASR ASR |
$182.36
|
| Rate for Payer: BCBS Trust/PPO |
$154.39
|
| Rate for Payer: BCN Commercial |
$154.39
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$176.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$182.36
|
| Rate for Payer: Healthscope Whirlpool |
$188.00
|
| Rate for Payer: Mclaren Commercial |
$169.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.44
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
OP
|
$5.63
|
|
|
Service Code
|
NDC 406851023
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: ASR ASR |
$5.46
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: BCBS Trust/PPO |
$4.64
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Commercial |
$5.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.46
|
| Rate for Payer: Healthscope Whirlpool |
$5.63
|
| Rate for Payer: Mclaren Commercial |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Nomi Health Commercial |
$4.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.93
|
| Rate for Payer: Priority Health Narrow Network |
$3.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
IP
|
$5.63
|
|
|
Service Code
|
NDC 406851023
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$5.63 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: ASR ASR |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.62
|
| Rate for Payer: BCN Commercial |
$4.62
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Commercial |
$5.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.46
|
| Rate for Payer: Healthscope Whirlpool |
$5.63
|
| Rate for Payer: Mclaren Commercial |
$5.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Nomi Health Commercial |
$4.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.95
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
OP
|
$562.80
|
|
|
Service Code
|
NDC 406851062
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.24 |
| Max. Negotiated Rate |
$562.80 |
| Rate for Payer: Aetna Commercial |
$506.52
|
| Rate for Payer: Aetna Medicare |
$208.24
|
| Rate for Payer: ASR ASR |
$545.92
|
| Rate for Payer: BCBS Complete |
$225.12
|
| Rate for Payer: BCBS Trust/PPO |
$464.03
|
| Rate for Payer: BCN Commercial |
$464.03
|
| Rate for Payer: Cash Price |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$529.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.24
|
| Rate for Payer: Healthscope Commercial |
$545.92
|
| Rate for Payer: Healthscope Whirlpool |
$562.80
|
| Rate for Payer: Mclaren Commercial |
$506.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.38
|
| Rate for Payer: Nomi Health Commercial |
$461.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$493.13
|
| Rate for Payer: Priority Health Narrow Network |
$394.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.26
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
IP
|
$562.80
|
|
|
Service Code
|
NDC 406851062
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$422.10 |
| Max. Negotiated Rate |
$562.80 |
| Rate for Payer: Aetna Commercial |
$506.52
|
| Rate for Payer: ASR ASR |
$545.92
|
| Rate for Payer: BCBS Trust/PPO |
$462.17
|
| Rate for Payer: BCN Commercial |
$462.17
|
| Rate for Payer: Cash Price |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$529.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$450.24
|
| Rate for Payer: Healthscope Commercial |
$545.92
|
| Rate for Payer: Healthscope Whirlpool |
$562.80
|
| Rate for Payer: Mclaren Commercial |
$506.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.38
|
| Rate for Payer: Nomi Health Commercial |
$461.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$495.26
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$208.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.19 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna Commercial |
$187.43
|
| Rate for Payer: ASR ASR |
$202.00
|
| Rate for Payer: BCBS Trust/PPO |
$171.01
|
| Rate for Payer: BCN Commercial |
$171.01
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cofinity Commercial |
$195.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.60
|
| Rate for Payer: Healthscope Commercial |
$202.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.25
|
| Rate for Payer: Mclaren Commercial |
$187.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.01
|
| Rate for Payer: Nomi Health Commercial |
$170.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.26
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.12 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$292.95
|
| Rate for Payer: ASR ASR |
$315.74
|
| Rate for Payer: BCBS Trust/PPO |
$267.30
|
| Rate for Payer: BCN Commercial |
$267.30
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$315.74
|
| Rate for Payer: Healthscope Whirlpool |
$325.50
|
| Rate for Payer: Mclaren Commercial |
$292.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$266.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.44
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Medicare |
$77.70
|
| Rate for Payer: ASR ASR |
$203.70
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS Trust/PPO |
$173.15
|
| Rate for Payer: BCN Commercial |
$173.15
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$203.70
|
| Rate for Payer: Healthscope Whirlpool |
$210.00
|
| Rate for Payer: Mclaren Commercial |
$189.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$184.00
|
| Rate for Payer: Priority Health Narrow Network |
$147.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.80
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: ASR ASR |
$203.70
|
| Rate for Payer: BCBS Trust/PPO |
$172.45
|
| Rate for Payer: BCN Commercial |
$172.45
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$197.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.00
|
| Rate for Payer: Healthscope Commercial |
$203.70
|
| Rate for Payer: Healthscope Whirlpool |
$210.00
|
| Rate for Payer: Mclaren Commercial |
$189.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.50
|
| Rate for Payer: Nomi Health Commercial |
$172.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.80
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$208.25
|
|
|
Service Code
|
NDC 65162004710
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.05 |
| Max. Negotiated Rate |
$208.25 |
| Rate for Payer: Aetna Commercial |
$187.43
|
| Rate for Payer: Aetna Medicare |
$77.05
|
| Rate for Payer: ASR ASR |
$202.00
|
| Rate for Payer: BCBS Complete |
$83.30
|
| Rate for Payer: BCBS Trust/PPO |
$171.70
|
| Rate for Payer: BCN Commercial |
$171.70
|
| Rate for Payer: Cash Price |
$166.60
|
| Rate for Payer: Cofinity Commercial |
$195.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.60
|
| Rate for Payer: Healthscope Commercial |
$202.00
|
| Rate for Payer: Healthscope Whirlpool |
$208.25
|
| Rate for Payer: Mclaren Commercial |
$187.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.01
|
| Rate for Payer: Nomi Health Commercial |
$170.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$182.47
|
| Rate for Payer: Priority Health Narrow Network |
$145.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.26
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
NDC 406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$292.95
|
| Rate for Payer: Aetna Medicare |
$120.44
|
| Rate for Payer: ASR ASR |
$315.74
|
| Rate for Payer: BCBS Complete |
$130.20
|
| Rate for Payer: BCBS Trust/PPO |
$268.37
|
| Rate for Payer: BCN Commercial |
$268.37
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$315.74
|
| Rate for Payer: Healthscope Whirlpool |
$325.50
|
| Rate for Payer: Mclaren Commercial |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Nomi Health Commercial |
$266.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$285.20
|
| Rate for Payer: Priority Health Narrow Network |
$228.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.44
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$5.69
|
|
|
Service Code
|
NDC 50268064611
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.69 |
| Rate for Payer: Aetna Commercial |
$5.12
|
| Rate for Payer: ASR ASR |
$5.52
|
| Rate for Payer: BCBS Trust/PPO |
$4.67
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$5.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.52
|
| Rate for Payer: Healthscope Whirlpool |
$5.69
|
| Rate for Payer: Mclaren Commercial |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.84
|
| Rate for Payer: Nomi Health Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.01
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$1,071.70
|
|
|
Service Code
|
NDC 68084071001
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$396.53 |
| Max. Negotiated Rate |
$1,071.70 |
| Rate for Payer: Aetna Commercial |
$964.53
|
| Rate for Payer: Aetna Medicare |
$396.53
|
| Rate for Payer: ASR ASR |
$1,039.55
|
| Rate for Payer: BCBS Complete |
$428.68
|
| Rate for Payer: BCBS Trust/PPO |
$883.62
|
| Rate for Payer: BCN Commercial |
$883.62
|
| Rate for Payer: Cash Price |
$857.36
|
| Rate for Payer: Cofinity Commercial |
$1,007.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$857.36
|
| Rate for Payer: Healthscope Commercial |
$1,039.55
|
| Rate for Payer: Healthscope Whirlpool |
$1,071.70
|
| Rate for Payer: Mclaren Commercial |
$964.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$857.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.95
|
| Rate for Payer: Nomi Health Commercial |
$878.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$939.02
|
| Rate for Payer: Priority Health Narrow Network |
$751.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$943.10
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
NDC 68084071011
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$10.72 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: ASR ASR |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$8.80
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$8.57
|
| Rate for Payer: Cofinity Commercial |
$10.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Whirlpool |
$10.72
|
| Rate for Payer: Mclaren Commercial |
$9.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.11
|
| Rate for Payer: Nomi Health Commercial |
$8.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.43
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$284.55
|
|
|
Service Code
|
NDC 50268064615
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.41 |
| Max. Negotiated Rate |
$284.55 |
| Rate for Payer: Aetna Commercial |
$256.10
|
| Rate for Payer: ASR ASR |
$276.01
|
| Rate for Payer: BCBS Trust/PPO |
$233.67
|
| Rate for Payer: BCN Commercial |
$233.67
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Commercial |
$267.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$276.01
|
| Rate for Payer: Healthscope Whirlpool |
$284.55
|
| Rate for Payer: Mclaren Commercial |
$256.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: Nomi Health Commercial |
$233.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.40
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$284.55
|
|
|
Service Code
|
NDC 50268064615
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.28 |
| Max. Negotiated Rate |
$284.55 |
| Rate for Payer: Aetna Commercial |
$256.10
|
| Rate for Payer: Aetna Medicare |
$105.28
|
| Rate for Payer: ASR ASR |
$276.01
|
| Rate for Payer: BCBS Complete |
$113.82
|
| Rate for Payer: BCBS Trust/PPO |
$234.61
|
| Rate for Payer: BCN Commercial |
$234.61
|
| Rate for Payer: Cash Price |
$227.64
|
| Rate for Payer: Cofinity Commercial |
$267.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$276.01
|
| Rate for Payer: Healthscope Whirlpool |
$284.55
|
| Rate for Payer: Mclaren Commercial |
$256.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$227.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.87
|
| Rate for Payer: Nomi Health Commercial |
$233.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$249.32
|
| Rate for Payer: Priority Health Narrow Network |
$199.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.40
|
|
