|
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 |
$247.10
|
| 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 |
$247.10
|
| 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
|
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
|
IP
|
$302.10
|
|
|
Service Code
|
NDC 00832003801
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.36 |
| 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 |
$256.78
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| 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
|
$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 |
$247.10
|
| 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 |
$247.10
|
| 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
|
$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
|
$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
|
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
|
$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 |
$162.92
|
| 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 |
$256.78
|
| Rate for Payer: Nomi Health Commercial |
$247.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.36
|
| 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
|
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 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
|
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
|
|
|
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
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
IP
|
$422.80
|
|
|
Service Code
|
NDC 00406851062
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.82 |
| Max. Negotiated Rate |
$422.80 |
| Rate for Payer: Aetna Commercial |
$380.52
|
| Rate for Payer: ASR ASR |
$410.12
|
| Rate for Payer: ASR Commercial |
$410.12
|
| Rate for Payer: BCBS Trust/PPO |
$344.54
|
| Rate for Payer: BCN Commercial |
$327.80
|
| Rate for Payer: Cash Price |
$338.24
|
| Rate for Payer: Cofinity Commercial |
$397.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.24
|
| Rate for Payer: Healthscope Commercial |
$422.80
|
| Rate for Payer: Healthscope Whirlpool |
$410.12
|
| Rate for Payer: Mclaren Commercial |
$380.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.38
|
| Rate for Payer: Nomi Health Commercial |
$346.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.06
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
OP
|
$422.80
|
|
|
Service Code
|
NDC 00406851062
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.12 |
| Max. Negotiated Rate |
$422.80 |
| Rate for Payer: Aetna Commercial |
$380.52
|
| Rate for Payer: Aetna Medicare |
$211.40
|
| Rate for Payer: ASR ASR |
$410.12
|
| Rate for Payer: ASR Commercial |
$410.12
|
| Rate for Payer: BCBS Complete |
$169.12
|
| Rate for Payer: BCBS Trust/PPO |
$346.23
|
| Rate for Payer: BCN Commercial |
$327.80
|
| Rate for Payer: Cash Price |
$338.24
|
| Rate for Payer: Cofinity Commercial |
$397.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.24
|
| Rate for Payer: Healthscope Commercial |
$422.80
|
| Rate for Payer: Healthscope Whirlpool |
$410.12
|
| Rate for Payer: Mclaren Commercial |
$380.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.38
|
| Rate for Payer: Nomi Health Commercial |
$346.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$370.46
|
| Rate for Payer: Priority Health Narrow Network |
$296.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.06
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 00406851023
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: ASR ASR |
$4.10
|
| Rate for Payer: ASR Commercial |
$4.10
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Healthscope Whirlpool |
$4.10
|
| Rate for Payer: Mclaren Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.72
|
|
|
OXYCODONE 10 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 00406851023
|
| Hospital Charge Code |
87795
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: ASR ASR |
$4.10
|
| Rate for Payer: ASR Commercial |
$4.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Healthscope Whirlpool |
$4.10
|
| Rate for Payer: Mclaren Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.72
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
NDC 00406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$292.95
|
| Rate for Payer: Aetna Medicare |
$162.75
|
| Rate for Payer: ASR ASR |
$315.74
|
| Rate for Payer: ASR Commercial |
$315.74
|
| Rate for Payer: BCBS Complete |
$130.20
|
| Rate for Payer: BCBS Trust/PPO |
$266.55
|
| Rate for Payer: BCN Commercial |
$252.36
|
| 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 |
$325.50
|
| Rate for Payer: Healthscope Whirlpool |
$315.74
|
| 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: Priority Health Cigna Priority Health |
$211.58
|
| Rate for Payer: 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 5 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 00406055201
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.58 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$292.95
|
| Rate for Payer: ASR ASR |
$315.74
|
| Rate for Payer: ASR Commercial |
$315.74
|
| Rate for Payer: BCBS Trust/PPO |
$265.25
|
| Rate for Payer: BCN Commercial |
$252.36
|
| 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 |
$325.50
|
| Rate for Payer: Healthscope Whirlpool |
$315.74
|
| 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: Priority Health Cigna Priority Health |
$211.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.44
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
OP
|
$204.75
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$184.28
|
| Rate for Payer: Aetna Medicare |
$102.38
|
| Rate for Payer: ASR ASR |
$198.61
|
| Rate for Payer: ASR Commercial |
$198.61
|
| Rate for Payer: BCBS Complete |
$81.90
|
| Rate for Payer: BCBS Trust/PPO |
$167.67
|
| Rate for Payer: BCN Commercial |
$158.74
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Healthscope Whirlpool |
$198.61
|
| Rate for Payer: Mclaren Commercial |
$184.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: Nomi Health Commercial |
$167.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.40
|
| Rate for Payer: Priority Health Narrow Network |
$143.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.18
|
|
|
OXYCODONE 5 MG TABLET
|
Facility
|
IP
|
$204.75
|
|
|
Service Code
|
NDC 42858000101
|
| Hospital Charge Code |
10814
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.09 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$184.28
|
| Rate for Payer: ASR ASR |
$198.61
|
| Rate for Payer: ASR Commercial |
$198.61
|
| Rate for Payer: BCBS Trust/PPO |
$166.85
|
| Rate for Payer: BCN Commercial |
$158.74
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$192.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Healthscope Whirlpool |
$198.61
|
| Rate for Payer: Mclaren Commercial |
$184.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: Nomi Health Commercial |
$167.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.18
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
IP
|
$277.55
|
|
|
Service Code
|
NDC 50268064615
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.41 |
| Max. Negotiated Rate |
$277.55 |
| Rate for Payer: Aetna Commercial |
$249.80
|
| Rate for Payer: ASR ASR |
$269.22
|
| Rate for Payer: ASR Commercial |
$269.22
|
| Rate for Payer: BCBS Trust/PPO |
$226.18
|
| Rate for Payer: BCN Commercial |
$215.18
|
| Rate for Payer: Cash Price |
$222.04
|
| Rate for Payer: Cofinity Commercial |
$260.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.04
|
| Rate for Payer: Healthscope Commercial |
$277.55
|
| Rate for Payer: Healthscope Whirlpool |
$269.22
|
| Rate for Payer: Mclaren Commercial |
$249.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.92
|
| Rate for Payer: Nomi Health Commercial |
$227.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.24
|
|
|
OXYCODONE-ACETAMINOPHEN 10 MG-325 MG TABLET
|
Facility
|
OP
|
$5.55
|
|
|
Service Code
|
NDC 50268064611
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$5.55 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: ASR ASR |
$5.38
|
| Rate for Payer: ASR Commercial |
$5.38
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$4.54
|
| Rate for Payer: BCN Commercial |
$4.30
|
| Rate for Payer: Cash Price |
$4.44
|
| Rate for Payer: Cofinity Commercial |
$5.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$5.55
|
| Rate for Payer: Healthscope Whirlpool |
$5.38
|
| Rate for Payer: Mclaren Commercial |
$5.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.72
|
| Rate for Payer: Nomi Health Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.86
|
| Rate for Payer: Priority Health Narrow Network |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.88
|
|
