|
OPEN TREATMENT OF ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,893.77
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
ORCHIOPEXY, INGUINAL OR SCROTAL APPROACH
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,937.74
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$10,363.71
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$9,327.34 |
| Rate for Payer: Aetna Commercial |
$8,809.15
|
| Rate for Payer: Aetna Commercial |
$2,936.38
|
| Rate for Payer: Aetna Medicare |
$29.83
|
| Rate for Payer: Aetna Medicare |
$29.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,736.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,245.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.85
|
| Rate for Payer: BCBS Complete |
$16.14
|
| Rate for Payer: BCBS Complete |
$16.14
|
| Rate for Payer: BCBS MAPPO |
$28.68
|
| Rate for Payer: BCBS MAPPO |
$28.68
|
| Rate for Payer: BCN Medicare Advantage |
$28.68
|
| Rate for Payer: BCN Medicare Advantage |
$28.68
|
| Rate for Payer: Cash Price |
$2,763.66
|
| Rate for Payer: Cash Price |
$2,763.66
|
| Rate for Payer: Cash Price |
$8,290.97
|
| Rate for Payer: Cash Price |
$8,290.97
|
| Rate for Payer: Cofinity Commercial |
$2,418.20
|
| Rate for Payer: Cofinity Commercial |
$2,970.93
|
| Rate for Payer: Cofinity Commercial |
$8,912.79
|
| Rate for Payer: Cofinity Commercial |
$7,254.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,254.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,418.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,763.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,290.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.68
|
| Rate for Payer: Healthscope Commercial |
$9,327.34
|
| Rate for Payer: Healthscope Commercial |
$3,109.11
|
| Rate for Payer: Mclaren Medicaid |
$15.37
|
| Rate for Payer: Mclaren Medicaid |
$15.37
|
| Rate for Payer: Mclaren Medicare |
$28.68
|
| Rate for Payer: Mclaren Medicare |
$28.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.11
|
| Rate for Payer: Meridian Medicaid |
$16.14
|
| Rate for Payer: Meridian Medicaid |
$16.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,809.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,936.38
|
| Rate for Payer: PACE Medicare |
$27.25
|
| Rate for Payer: PACE Medicare |
$27.25
|
| Rate for Payer: PACE SWMI |
$28.68
|
| Rate for Payer: PACE SWMI |
$28.68
|
| Rate for Payer: PHP Commercial |
$2,936.38
|
| Rate for Payer: PHP Commercial |
$8,809.15
|
| Rate for Payer: PHP Medicare Advantage |
$28.68
|
| Rate for Payer: PHP Medicare Advantage |
$28.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,736.41
|
| Rate for Payer: Priority Health Medicare |
$28.68
|
| Rate for Payer: Priority Health Medicare |
$28.68
|
| Rate for Payer: Priority Health SBD |
$2,176.38
|
| Rate for Payer: Priority Health SBD |
$6,529.14
|
| Rate for Payer: Railroad Medicare Medicare |
$28.68
|
| Rate for Payer: Railroad Medicare Medicare |
$28.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.68
|
| Rate for Payer: UHC Medicare Advantage |
$28.68
|
| Rate for Payer: UHC Medicare Advantage |
$28.68
|
| Rate for Payer: UHCCP Medicaid |
$16.15
|
| Rate for Payer: UHCCP Medicaid |
$16.15
|
| Rate for Payer: VA VA |
$28.68
|
| Rate for Payer: VA VA |
$28.68
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,454.57
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,176.38 |
| Max. Negotiated Rate |
$3,109.11 |
| Rate for Payer: Aetna Commercial |
$2,936.38
|
| Rate for Payer: Aetna Commercial |
$8,809.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,736.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,245.47
|
| Rate for Payer: Cash Price |
$8,290.97
|
| Rate for Payer: Cash Price |
$2,763.66
|
| Rate for Payer: Cofinity Commercial |
$2,970.93
|
| Rate for Payer: Cofinity Commercial |
$2,418.20
|
| Rate for Payer: Cofinity Commercial |
$7,254.60
|
| Rate for Payer: Cofinity Commercial |
$8,912.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,254.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,418.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,290.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,763.66
|
| Rate for Payer: Healthscope Commercial |
$3,109.11
|
| Rate for Payer: Healthscope Commercial |
$9,327.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,809.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,936.38
|
| Rate for Payer: PHP Commercial |
$2,936.38
|
| Rate for Payer: PHP Commercial |
$8,809.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,736.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.47
|
| Rate for Payer: Priority Health SBD |
$6,529.14
|
| Rate for Payer: Priority Health SBD |
$2,176.38
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$60.02
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.81 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$51.91
|
| Rate for Payer: Cofinity Commercial |
$42.25
|
| Rate for Payer: Cofinity Commercial |
$30.92
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$42.01
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.29
|
| Rate for Payer: Healthscope Commercial |
$39.75
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$54.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$51.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: Priority Health SBD |
$37.81
|
| Rate for Payer: Priority Health SBD |
$27.83
|
| Rate for Payer: Priority Health SBD |
$38.03
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$60.02
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Medicare |
$30.18
|
| Rate for Payer: Aetna Medicare |
$30.01
|
| Rate for Payer: Aetna Medicare |
$22.09
|
| Rate for Payer: Aetna Medicare |
$21.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.23
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS Complete |
$24.01
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Cofinity Commercial |
$51.91
|
| Rate for Payer: Cofinity Commercial |
$42.01
|
| Rate for Payer: Cofinity Commercial |
$42.25
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$30.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.34
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$39.75
|
| Rate for Payer: Healthscope Commercial |
$54.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$51.31
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: Priority Health SBD |
$37.81
|
| Rate for Payer: Priority Health SBD |
$27.83
|
| Rate for Payer: Priority Health SBD |
$38.03
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.82 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$161.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$202.89
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$39.17
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.67 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.46
|
| Rate for Payer: BCBS Complete |
$15.67
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$27.42
|
| Rate for Payer: Cofinity Commercial |
$33.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health SBD |
$24.68
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$73.68
|
|
|
Service Code
|
NDC 72205004211
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$62.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.89
|
| Rate for Payer: Cash Price |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$51.58
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.94
|
| Rate for Payer: Healthscope Commercial |
$66.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.63
|
| Rate for Payer: PHP Commercial |
$62.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.89
|
| Rate for Payer: Priority Health SBD |
$46.42
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$73.68
|
|
|
Service Code
|
NDC 72205004211
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.47 |
| Max. Negotiated Rate |
$66.31 |
| Rate for Payer: Aetna Commercial |
$62.63
|
| Rate for Payer: Aetna Medicare |
$36.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.89
|
| Rate for Payer: BCBS Complete |
$29.47
|
| Rate for Payer: Cash Price |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$51.58
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.94
|
| Rate for Payer: Healthscope Commercial |
$66.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.63
|
| Rate for Payer: PHP Commercial |
$62.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.89
|
| Rate for Payer: Priority Health SBD |
$46.42
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.49
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.08 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.67
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$335.64
|
| Rate for Payer: Cofinity Commercial |
$412.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.59
|
| Rate for Payer: Healthscope Commercial |
$431.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.57
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.67
|
| Rate for Payer: Priority Health SBD |
$302.08
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$39.17
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.68 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.46
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$27.42
|
| Rate for Payer: Cofinity Commercial |
$33.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health SBD |
$24.68
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$479.49
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.67
|
| Rate for Payer: BCBS Complete |
$191.80
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$335.64
|
| Rate for Payer: Cofinity Commercial |
$412.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$335.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.59
|
| Rate for Payer: Healthscope Commercial |
$431.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.57
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.67
|
| Rate for Payer: Priority Health SBD |
$302.08
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.89 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$225.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: Priority Health SBD |
$202.89
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$447.56
|
|
|
Service Code
|
NDC 47781038426
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.02 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Aetna Medicare |
$223.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.91
|
| Rate for Payer: BCBS Complete |
$179.02
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cofinity Commercial |
$313.29
|
| Rate for Payer: Cofinity Commercial |
$384.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.05
|
| Rate for Payer: Healthscope Commercial |
$402.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.43
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.91
|
| Rate for Payer: Priority Health SBD |
$281.96
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$522.59
|
|
|
Service Code
|
NDC 00004082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.04 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: Aetna Medicare |
$261.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.68
|
| Rate for Payer: BCBS Complete |
$209.04
|
| Rate for Payer: Cash Price |
$418.07
|
| Rate for Payer: Cofinity Commercial |
$365.81
|
| Rate for Payer: Cofinity Commercial |
$449.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.07
|
| Rate for Payer: Healthscope Commercial |
$470.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.20
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.68
|
| Rate for Payer: Priority Health SBD |
$329.23
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$447.56
|
|
|
Service Code
|
NDC 47781038426
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.96 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.91
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cofinity Commercial |
$313.29
|
| Rate for Payer: Cofinity Commercial |
$384.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$313.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.05
|
| Rate for Payer: Healthscope Commercial |
$402.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.43
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.91
|
| Rate for Payer: Priority Health SBD |
$281.96
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$522.59
|
|
|
Service Code
|
NDC 00004082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.23 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.68
|
| Rate for Payer: Cash Price |
$418.07
|
| Rate for Payer: Cofinity Commercial |
$365.81
|
| Rate for Payer: Cofinity Commercial |
$449.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.07
|
| Rate for Payer: Healthscope Commercial |
$470.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.20
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.68
|
| Rate for Payer: Priority Health SBD |
$329.23
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$82.61
|
|
|
Service Code
|
NDC 64380079901
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$74.35 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$41.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.70
|
| Rate for Payer: BCBS Complete |
$33.04
|
| Rate for Payer: Cash Price |
$66.09
|
| Rate for Payer: Cofinity Commercial |
$57.83
|
| Rate for Payer: Cofinity Commercial |
$71.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.09
|
| Rate for Payer: Healthscope Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.22
|
| Rate for Payer: PHP Commercial |
$70.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health SBD |
$52.04
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.26 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.71
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$365.84
|
| Rate for Payer: Cofinity Commercial |
$449.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.24
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.71
|
| Rate for Payer: Priority Health SBD |
$329.26
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: Aetna Medicare |
$261.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.71
|
| Rate for Payer: BCBS Complete |
$209.05
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$365.84
|
| Rate for Payer: Cofinity Commercial |
$449.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.24
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.71
|
| Rate for Payer: Priority Health SBD |
$329.26
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$351.02
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.14 |
| Max. Negotiated Rate |
$315.92 |
| Rate for Payer: Aetna Commercial |
$298.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.16
|
| Rate for Payer: Cash Price |
$280.82
|
| Rate for Payer: Cofinity Commercial |
$245.71
|
| Rate for Payer: Cofinity Commercial |
$301.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.82
|
| Rate for Payer: Healthscope Commercial |
$315.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.37
|
| Rate for Payer: PHP Commercial |
$298.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.16
|
| Rate for Payer: Priority Health SBD |
$221.14
|
|
