|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.45
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$9.73
|
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$7.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.11
|
| Rate for Payer: BCBS Trust/PPO |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCBS Trust/PPO |
$8.08
|
| Rate for Payer: BCBS Trust/PPO |
$8.85
|
| Rate for Payer: BCN Commercial |
$8.11
|
| Rate for Payer: BCN Commercial |
$9.58
|
| Rate for Payer: BCN Commercial |
$13.36
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$7.03
|
| Rate for Payer: BCN Commercial |
$8.85
|
| Rate for Payer: BCN Commercial |
$17.50
|
| Rate for Payer: BCN Commercial |
$9.39
|
| Rate for Payer: BCN Commercial |
$8.08
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$9.16
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$8.99
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$20.38
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.25
|
| Rate for Payer: PHP Commercial |
$9.73
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$10.54
|
| Rate for Payer: PHP Commercial |
$10.33
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$8.92
|
| Rate for Payer: PHP Commercial |
$19.25
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.93
|
| Rate for Payer: UHC Core |
$12.88
|
| Rate for Payer: UHC Core |
$10.15
|
| Rate for Payer: UHC Core |
$8.73
|
| Rate for Payer: UHC Core |
$7.60
|
| Rate for Payer: UHC Core |
$18.91
|
| Rate for Payer: UHC Core |
$8.77
|
| Rate for Payer: UHC Core |
$9.56
|
| Rate for Payer: UHC Core |
$14.44
|
| Rate for Payer: UHC Core |
$10.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
|
|
OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$4,927.66
|
|
|
Service Code
|
CPT 23515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,693.01 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
|
|
OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$4,927.66
|
|
|
Service Code
|
CPT 27792
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,693.01 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
|
|
OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WITH INTERNAL FIXATION
|
Facility
|
OP
|
$4,927.66
|
|
|
Service Code
|
CPT 25607
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,693.01 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
|
|
OPEN TREATMENT OF DISTAL TIBIOFIBULAR JOINT (SYNDESMOSIS) DISRUPTION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$4,927.66
|
|
|
Service Code
|
CPT 27829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,693.01 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
|
|
OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$43.19
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: BCBS Trust/PPO |
$46.38
|
| Rate for Payer: BCBS Trust/PPO |
$33.38
|
| Rate for Payer: BCN Commercial |
$33.38
|
| Rate for Payer: BCN Commercial |
$46.38
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.02
|
| Rate for Payer: Healthscope Commercial |
$54.02
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.02
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.01
|
| Rate for Payer: UHC Core |
$36.06
|
| Rate for Payer: UHC Core |
$50.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.02
|
|
|
ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS J7324
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$169.02 |
| Rate for Payer: Aetna Commercial |
$157.29
|
| Rate for Payer: Aetna Medicare |
$122.07
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$117.38
|
| Rate for Payer: BCBS Trust/PPO |
$133.10
|
| Rate for Payer: BCN Commercial |
$130.97
|
| Rate for Payer: BCN Medicare Advantage |
$117.38
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$157.29
|
| Rate for Payer: Cofinity Commercial |
$169.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.25
|
| Rate for Payer: PACE SWMI |
$117.38
|
| Rate for Payer: PHP Medicare Advantage |
$117.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health Medicare |
$117.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.38
|
| Rate for Payer: UHC Medicare Advantage |
$120.90
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.49
|
|
|
Service Code
|
NDC 0004-0802-85
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.44 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: BCBS Trust/PPO |
$370.55
|
| Rate for Payer: BCN Commercial |
$370.55
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$412.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.59
|
| Rate for Payer: Healthscope Commercial |
$431.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.57
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.95
|
| Rate for Payer: UHC Core |
$400.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.62
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$38.74
|
|
|
Service Code
|
NDC 68180-675-11
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.63 |
| Max. Negotiated Rate |
$34.87 |
| Rate for Payer: Aetna Commercial |
$32.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.94
|
| Rate for Payer: BCN Commercial |
$29.94
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$33.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Healthscope Commercial |
$34.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: PHP Commercial |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.09
|
| Rate for Payer: UHC Core |
$32.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.06
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$27.75
|
|
|
Service Code
|
NDC 9900-0007-90
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Aetna Commercial |
$23.59
|
| Rate for Payer: BCBS Trust/PPO |
$21.45
|
| Rate for Payer: BCN Commercial |
$21.45
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$24.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.59
|
| Rate for Payer: PHP Commercial |
$23.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.42
|
| Rate for Payer: UHC Core |
$23.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.81
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.06 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$176.20
|
| Rate for Payer: BCN Commercial |
$176.20
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$447.56
|
|
|
Service Code
|
NDC 47781-384-26
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.97 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: BCBS Trust/PPO |
$345.87
|
| Rate for Payer: BCN Commercial |
$345.87
|
| Rate for Payer: Cash Price |
$358.05
|
| Rate for Payer: Cofinity Commercial |
$384.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.05
|
| Rate for Payer: Healthscope Commercial |
$402.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.43
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$272.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.85
|
| Rate for Payer: UHC Core |
$373.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.67
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$522.59
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.73 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: BCBS Trust/PPO |
$403.86
|
| Rate for Payer: BCN Commercial |
$403.86
|
| Rate for Payer: Cash Price |
$418.07
|
| Rate for Payer: Cofinity Commercial |
$449.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.07
|
| Rate for Payer: Healthscope Commercial |
$470.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.20
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.88
|
| Rate for Payer: UHC Core |
$436.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.94
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: BCBS Trust/PPO |
$403.89
|
| Rate for Payer: BCN Commercial |
$403.89
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$449.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.24
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.91
|
| Rate for Payer: UHC Core |
$436.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$52.42
|
|
|
Service Code
|
NDC 68180-677-11
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$47.18 |
| Rate for Payer: Aetna Commercial |
$44.56
|
| Rate for Payer: BCBS Trust/PPO |
$40.51
|
| Rate for Payer: BCN Commercial |
$40.51
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Cofinity Commercial |
$45.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.94
|
| Rate for Payer: Healthscope Commercial |
$47.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.56
|
| Rate for Payer: PHP Commercial |
$44.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.13
|
| Rate for Payer: UHC Core |
$43.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.32
|
|
|
OSTECTOMY, CALCANEUS;
|
Facility
|
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
OSTECTOMY, EXCISION OF TARSAL COALITION
|
Facility
|
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$832.13
|
|
|
Service Code
|
NDC 62584-813-01
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$507.52 |
| Max. Negotiated Rate |
$748.92 |
| Rate for Payer: Aetna Commercial |
$707.31
|
| Rate for Payer: BCBS Trust/PPO |
$643.07
|
| Rate for Payer: BCN Commercial |
$643.07
|
| Rate for Payer: Cash Price |
$665.70
|
| Rate for Payer: Cofinity Commercial |
$715.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$665.70
|
| Rate for Payer: Healthscope Commercial |
$748.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$624.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$707.31
|
| Rate for Payer: PHP Commercial |
$707.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$723.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$507.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$732.27
|
| Rate for Payer: UHC Core |
$694.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$624.10
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$8.33
|
|
|
Service Code
|
NDC 62584-813-11
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$7.08
|
| Rate for Payer: BCBS Trust/PPO |
$6.44
|
| Rate for Payer: BCN Commercial |
$6.44
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.08
|
| Rate for Payer: PHP Commercial |
$7.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.33
|
| Rate for Payer: UHC Core |
$6.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.25
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084-853-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$268.70 |
| Rate for Payer: Aetna Commercial |
$253.78
|
| Rate for Payer: BCBS Trust/PPO |
$230.73
|
| Rate for Payer: BCN Commercial |
$230.73
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$256.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$268.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.78
|
| Rate for Payer: PHP Commercial |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.73
|
| Rate for Payer: UHC Core |
$249.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.92
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 51991-293-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: BCBS Trust/PPO |
$323.26
|
| Rate for Payer: BCN Commercial |
$323.26
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.10
|
| Rate for Payer: UHC Core |
$349.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084-853-11
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.63
|
| Rate for Payer: UHC Core |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.24
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084-400-01
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.70 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: BCBS Trust/PPO |
$274.58
|
| Rate for Payer: BCN Commercial |
$274.58
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$309.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.66
|
| Rate for Payer: UHC Core |
$296.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
