|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$53.95
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: ASR ASR |
$52.33
|
| Rate for Payer: ASR Commercial |
$52.33
|
| Rate for Payer: BCBS Trust/PPO |
$43.96
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$53.95
|
| Rate for Payer: Healthscope Whirlpool |
$52.33
|
| Rate for Payer: Mclaren Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.86
|
| Rate for Payer: Nomi Health Commercial |
$44.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.48
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$276.20
|
|
|
Service Code
|
NDC 70710101002
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.53 |
| Max. Negotiated Rate |
$276.20 |
| Rate for Payer: Aetna Commercial |
$248.58
|
| Rate for Payer: ASR ASR |
$267.91
|
| Rate for Payer: ASR Commercial |
$267.91
|
| Rate for Payer: BCBS Trust/PPO |
$225.08
|
| Rate for Payer: BCN Commercial |
$214.14
|
| Rate for Payer: Cash Price |
$220.96
|
| Rate for Payer: Cofinity Commercial |
$259.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.96
|
| Rate for Payer: Healthscope Commercial |
$276.20
|
| Rate for Payer: Healthscope Whirlpool |
$267.91
|
| Rate for Payer: Mclaren Commercial |
$248.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.77
|
| Rate for Payer: Nomi Health Commercial |
$226.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.06
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$275.24
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: Aetna Medicare |
$137.62
|
| Rate for Payer: ASR ASR |
$266.98
|
| Rate for Payer: ASR Commercial |
$266.98
|
| Rate for Payer: BCBS Complete |
$110.10
|
| Rate for Payer: BCBS Trust/PPO |
$225.39
|
| Rate for Payer: BCN Commercial |
$213.39
|
| Rate for Payer: Cash Price |
$220.19
|
| Rate for Payer: Cofinity Commercial |
$258.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.19
|
| Rate for Payer: Healthscope Commercial |
$275.24
|
| Rate for Payer: Healthscope Whirlpool |
$266.98
|
| Rate for Payer: Mclaren Commercial |
$247.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.95
|
| Rate for Payer: Nomi Health Commercial |
$225.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.17
|
| Rate for Payer: Priority Health Narrow Network |
$192.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.21
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.62
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$522.62 |
| Rate for Payer: Aetna Commercial |
$470.36
|
| Rate for Payer: Aetna Medicare |
$261.31
|
| Rate for Payer: ASR ASR |
$506.94
|
| Rate for Payer: ASR Commercial |
$506.94
|
| Rate for Payer: BCBS Complete |
$209.05
|
| Rate for Payer: BCBS Trust/PPO |
$427.97
|
| Rate for Payer: BCN Commercial |
$405.19
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$491.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$522.62
|
| Rate for Payer: Healthscope Whirlpool |
$506.94
|
| Rate for Payer: Mclaren Commercial |
$470.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.23
|
| Rate for Payer: Nomi Health Commercial |
$428.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.92
|
| Rate for Payer: Priority Health Narrow Network |
$366.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.91
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$53.95
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$48.55
|
| Rate for Payer: Aetna Medicare |
$26.98
|
| Rate for Payer: ASR ASR |
$52.33
|
| Rate for Payer: ASR Commercial |
$52.33
|
| Rate for Payer: BCBS Complete |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$44.18
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$53.95
|
| Rate for Payer: Healthscope Whirlpool |
$52.33
|
| Rate for Payer: Mclaren Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.86
|
| Rate for Payer: Nomi Health Commercial |
$44.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.27
|
| Rate for Payer: Priority Health Narrow Network |
$37.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.48
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.06 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$268.70
|
| Rate for Payer: ASR ASR |
$289.60
|
| Rate for Payer: ASR Commercial |
$289.60
|
| Rate for Payer: BCBS Trust/PPO |
$243.30
|
| Rate for Payer: BCN Commercial |
$231.47
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$298.56
|
| Rate for Payer: Healthscope Whirlpool |
$289.60
|
| Rate for Payer: Mclaren Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.73
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: ASR ASR |
$2.90
|
| Rate for Payer: ASR Commercial |
$2.90
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.45
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Mclaren Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Nomi Health Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.62
|
| Rate for Payer: Priority Health Narrow Network |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.63
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.42 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$268.70
|
| Rate for Payer: Aetna Medicare |
$149.28
|
| Rate for Payer: ASR ASR |
$289.60
|
| Rate for Payer: ASR Commercial |
$289.60
|
| Rate for Payer: BCBS Complete |
$119.42
|
| Rate for Payer: BCBS Trust/PPO |
$244.49
|
| Rate for Payer: BCN Commercial |
$231.47
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$298.56
|
| Rate for Payer: Healthscope Whirlpool |
$289.60
|
| Rate for Payer: Mclaren Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.60
|
| Rate for Payer: Priority Health Narrow Network |
$209.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.73
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: ASR ASR |
$2.90
|
| Rate for Payer: ASR Commercial |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Mclaren Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Nomi Health Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.63
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 68084040011
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna Commercial |
$319.77
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: ASR ASR |
$344.64
|
| Rate for Payer: ASR Commercial |
$344.64
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS Trust/PPO |
$290.96
|
| Rate for Payer: BCN Commercial |
$275.46
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$333.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$355.30
|
| Rate for Payer: Healthscope Whirlpool |
$344.64
|
| Rate for Payer: Mclaren Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.31
|
| Rate for Payer: Priority Health Narrow Network |
$249.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna Commercial |
$319.77
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: ASR ASR |
$344.64
|
| Rate for Payer: ASR Commercial |
$344.64
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: BCBS Trust/PPO |
$290.96
|
| Rate for Payer: BCN Commercial |
$275.46
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$333.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$355.30
|
| Rate for Payer: Healthscope Whirlpool |
$344.64
|
| Rate for Payer: Mclaren Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.31
|
| Rate for Payer: Priority Health Narrow Network |
$249.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.37 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: ASR Commercial |
$293.04
|
| Rate for Payer: BCBS Trust/PPO |
$246.18
|
| Rate for Payer: BCN Commercial |
$234.22
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$302.10
|
| Rate for Payer: Healthscope Whirlpool |
$293.04
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040011
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.94 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna Commercial |
$319.77
|
| Rate for Payer: ASR ASR |
$344.64
|
| Rate for Payer: ASR Commercial |
$344.64
|
| Rate for Payer: BCBS Trust/PPO |
$289.53
|
| Rate for Payer: BCN Commercial |
$275.46
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$333.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$355.30
|
| Rate for Payer: Healthscope Whirlpool |
$344.64
|
| Rate for Payer: Mclaren Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.72
|
| Rate for Payer: ASR ASR |
$2.93
|
| Rate for Payer: ASR Commercial |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$2.46
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Healthscope Whirlpool |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$274.55
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.82 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: Aetna Medicare |
$137.28
|
| Rate for Payer: ASR ASR |
$266.31
|
| Rate for Payer: ASR Commercial |
$266.31
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: BCBS Trust/PPO |
$224.83
|
| Rate for Payer: BCN Commercial |
$212.86
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cofinity Commercial |
$258.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.64
|
| Rate for Payer: Healthscope Commercial |
$274.55
|
| Rate for Payer: Healthscope Whirlpool |
$266.31
|
| Rate for Payer: Mclaren Commercial |
$247.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.37
|
| Rate for Payer: Nomi Health Commercial |
$225.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.56
|
| Rate for Payer: Priority Health Narrow Network |
$192.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.60
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
NDC 00832003889
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.72
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: ASR ASR |
$2.93
|
| Rate for Payer: ASR Commercial |
$2.93
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Healthscope Whirlpool |
$2.93
|
| Rate for Payer: Mclaren Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.65
|
| Rate for Payer: Priority Health Narrow Network |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$274.55
|
|
|
Service Code
|
NDC 00904702761
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$274.55 |
| Rate for Payer: Aetna Commercial |
$247.09
|
| Rate for Payer: ASR ASR |
$266.31
|
| Rate for Payer: ASR Commercial |
$266.31
|
| Rate for Payer: BCBS Trust/PPO |
$223.73
|
| Rate for Payer: BCN Commercial |
$212.86
|
| Rate for Payer: Cash Price |
$219.64
|
| Rate for Payer: Cofinity Commercial |
$258.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.64
|
| Rate for Payer: Healthscope Commercial |
$274.55
|
| Rate for Payer: Healthscope Whirlpool |
$266.31
|
| Rate for Payer: Mclaren Commercial |
$247.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.37
|
| Rate for Payer: Nomi Health Commercial |
$225.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$241.60
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna Commercial |
$293.26
|
| Rate for Payer: Aetna Medicare |
$162.93
|
| Rate for Payer: ASR ASR |
$316.07
|
| Rate for Payer: ASR Commercial |
$316.07
|
| Rate for Payer: BCBS Complete |
$130.34
|
| Rate for Payer: BCBS Trust/PPO |
$266.84
|
| Rate for Payer: BCN Commercial |
$252.63
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$325.85
|
| Rate for Payer: Healthscope Whirlpool |
$316.07
|
| Rate for Payer: Mclaren Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Nomi Health Commercial |
$267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.51
|
| Rate for Payer: Priority Health Narrow Network |
$228.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.75
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
OP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.84 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$271.89
|
| Rate for Payer: Aetna Medicare |
$151.05
|
| Rate for Payer: ASR ASR |
$293.04
|
| Rate for Payer: ASR Commercial |
$293.04
|
| Rate for Payer: BCBS Complete |
$120.84
|
| Rate for Payer: BCBS Trust/PPO |
$247.39
|
| Rate for Payer: BCN Commercial |
$234.22
|
| Rate for Payer: Cash Price |
$241.68
|
| Rate for Payer: Cofinity Commercial |
$283.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.68
|
| Rate for Payer: Healthscope Commercial |
$302.10
|
| Rate for Payer: Healthscope Whirlpool |
$293.04
|
| Rate for Payer: Mclaren Commercial |
$271.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.79
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.70
|
| Rate for Payer: Priority Health Narrow Network |
$211.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.85
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084040001
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.94 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna Commercial |
$319.77
|
| Rate for Payer: ASR ASR |
$344.64
|
| Rate for Payer: ASR Commercial |
$344.64
|
| Rate for Payer: BCBS Trust/PPO |
$289.53
|
| Rate for Payer: BCN Commercial |
$275.46
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$333.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$355.30
|
| Rate for Payer: Healthscope Whirlpool |
$344.64
|
| Rate for Payer: Mclaren Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: Nomi Health Commercial |
$291.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.80 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna Commercial |
$293.26
|
| Rate for Payer: ASR ASR |
$316.07
|
| Rate for Payer: ASR Commercial |
$316.07
|
| Rate for Payer: BCBS Trust/PPO |
$265.54
|
| Rate for Payer: BCN Commercial |
$252.63
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$325.85
|
| Rate for Payer: Healthscope Whirlpool |
$316.07
|
| Rate for Payer: Mclaren Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Nomi Health Commercial |
$267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.75
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$225.60
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.24 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$203.04
|
| Rate for Payer: Aetna Medicare |
$112.80
|
| Rate for Payer: ASR ASR |
$218.83
|
| Rate for Payer: ASR Commercial |
$218.83
|
| Rate for Payer: BCBS Complete |
$90.24
|
| Rate for Payer: BCBS Trust/PPO |
$184.74
|
| Rate for Payer: BCN Commercial |
$174.91
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$218.83
|
| Rate for Payer: Mclaren Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.67
|
| Rate for Payer: Priority Health Narrow Network |
$158.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.53
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$572.16
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.86 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$514.94
|
| Rate for Payer: Aetna Medicare |
$286.08
|
| Rate for Payer: ASR ASR |
$555.00
|
| Rate for Payer: ASR Commercial |
$555.00
|
| Rate for Payer: BCBS Complete |
$228.86
|
| Rate for Payer: BCBS Trust/PPO |
$468.54
|
| Rate for Payer: BCN Commercial |
$443.60
|
| Rate for Payer: Cash Price |
$457.73
|
| Rate for Payer: Cofinity Commercial |
$537.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.73
|
| Rate for Payer: Healthscope Commercial |
$572.16
|
| Rate for Payer: Healthscope Whirlpool |
$555.00
|
| Rate for Payer: Mclaren Commercial |
$514.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.34
|
| Rate for Payer: Nomi Health Commercial |
$469.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.33
|
| Rate for Payer: Priority Health Narrow Network |
$401.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.50
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$572.16
|
|
|
Service Code
|
NDC 00904657061
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$371.90 |
| Max. Negotiated Rate |
$572.16 |
| Rate for Payer: Aetna Commercial |
$514.94
|
| Rate for Payer: ASR ASR |
$555.00
|
| Rate for Payer: ASR Commercial |
$555.00
|
| Rate for Payer: BCBS Trust/PPO |
$466.25
|
| Rate for Payer: BCN Commercial |
$443.60
|
| Rate for Payer: Cash Price |
$457.73
|
| Rate for Payer: Cofinity Commercial |
$537.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$457.73
|
| Rate for Payer: Healthscope Commercial |
$572.16
|
| Rate for Payer: Healthscope Whirlpool |
$555.00
|
| Rate for Payer: Mclaren Commercial |
$514.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$486.34
|
| Rate for Payer: Nomi Health Commercial |
$469.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$503.50
|
|
|
OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$225.60
|
|
|
Service Code
|
NDC 27241015504
|
| Hospital Charge Code |
24470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$203.04
|
| Rate for Payer: ASR ASR |
$218.83
|
| Rate for Payer: ASR Commercial |
$218.83
|
| Rate for Payer: BCBS Trust/PPO |
$183.84
|
| Rate for Payer: BCN Commercial |
$174.91
|
| Rate for Payer: Cash Price |
$180.48
|
| Rate for Payer: Cofinity Commercial |
$212.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.48
|
| Rate for Payer: Healthscope Commercial |
$225.60
|
| Rate for Payer: Healthscope Whirlpool |
$218.83
|
| Rate for Payer: Mclaren Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.76
|
| Rate for Payer: Nomi Health Commercial |
$184.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$198.53
|
|
