|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$5,890.99
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$5,610.46 |
| Max. Negotiated Rate |
$5,890.99 |
| Rate for Payer: BCBS Complete |
$5,890.99
|
| Rate for Payer: Mclaren Medicaid |
$5,610.46
|
| Rate for Payer: Meridian Medicaid |
$5,890.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,610.46
|
| Rate for Payer: UHC Medicaid |
$5,610.46
|
| Rate for Payer: UHCCP Medicaid |
$5,610.46
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$43.19
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Medicare |
$11.83
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna Medicare |
$15.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: BCBS Complete |
$11.17
|
| Rate for Payer: BCBS Complete |
$8.42
|
| Rate for Payer: BCBS Complete |
$7.99
|
| Rate for Payer: BCBS Complete |
$11.11
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$15.09
|
| Rate for Payer: BCBS MAPPO |
$15.01
|
| Rate for Payer: BCBS Trust/PPO |
$49.34
|
| Rate for Payer: BCBS Trust/PPO |
$35.51
|
| Rate for Payer: BCBS Trust/PPO |
$49.62
|
| Rate for Payer: BCBS Trust/PPO |
$37.41
|
| Rate for Payer: BCN Commercial |
$49.34
|
| Rate for Payer: BCN Commercial |
$49.62
|
| Rate for Payer: BCN Commercial |
$37.41
|
| Rate for Payer: BCN Commercial |
$35.51
|
| Rate for Payer: BCN Medicare Advantage |
$15.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.38
|
| Rate for Payer: BCN Medicare Advantage |
$15.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$51.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.01
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$54.02
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Mclaren Medicaid |
$10.58
|
| Rate for Payer: Mclaren Medicaid |
$8.02
|
| Rate for Payer: Mclaren Medicaid |
$7.61
|
| Rate for Payer: Mclaren Medicaid |
$10.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$11.11
|
| Rate for Payer: Meridian Medicaid |
$11.17
|
| Rate for Payer: Meridian Medicaid |
$8.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.31
|
| Rate for Payer: Nomi Health Commercial |
$49.22
|
| Rate for Payer: Nomi Health Commercial |
$35.42
|
| Rate for Payer: Nomi Health Commercial |
$37.32
|
| Rate for Payer: Nomi Health Commercial |
$49.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.39
|
| Rate for Payer: PACE Senior Care Partners |
$14.25
|
| Rate for Payer: PACE Senior Care Partners |
$14.34
|
| Rate for Payer: PACE Senior Care Partners |
$10.26
|
| Rate for Payer: PACE Senior Care Partners |
$10.81
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PACE SWMI |
$15.09
|
| Rate for Payer: PACE SWMI |
$11.38
|
| Rate for Payer: PACE SWMI |
$15.01
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$51.31
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: PHP Medicare Advantage |
$15.09
|
| Rate for Payer: PHP Medicare Advantage |
$11.38
|
| Rate for Payer: PHP Medicare Advantage |
$15.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.58
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Medicare |
$10.91
|
| Rate for Payer: Priority Health Medicare |
$15.16
|
| Rate for Payer: Priority Health Medicare |
$15.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15.01
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$15.09
|
| Rate for Payer: Railroad Medicare Medicare |
$11.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.12
|
| Rate for Payer: UHC Core |
$36.06
|
| Rate for Payer: UHC Core |
$50.12
|
| Rate for Payer: UHC Core |
$38.00
|
| Rate for Payer: UHC Core |
$50.40
|
| Rate for Payer: UHC Exchange |
$15.01
|
| Rate for Payer: UHC Exchange |
$11.38
|
| Rate for Payer: UHC Exchange |
$15.09
|
| Rate for Payer: UHC Exchange |
$10.80
|
| Rate for Payer: UHC Medicaid |
$7.61
|
| Rate for Payer: UHC Medicaid |
$8.02
|
| Rate for Payer: UHC Medicaid |
$10.58
|
| Rate for Payer: UHC Medicaid |
$10.64
|
| Rate for Payer: UHC Medicare Advantage |
$11.38
|
| Rate for Payer: UHC Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Medicare Advantage |
$15.09
|
| Rate for Payer: UHC Medicare Advantage |
$15.01
|
| Rate for Payer: UHCCP Medicaid |
$10.58
|
| Rate for Payer: UHCCP Medicaid |
$10.64
|
| Rate for Payer: UHCCP Medicaid |
$8.02
|
| Rate for Payer: UHCCP Medicaid |
$7.61
|
| Rate for Payer: VA VA |
$10.80
|
| Rate for Payer: VA VA |
$15.09
|
| Rate for Payer: VA VA |
$15.01
|
| Rate for Payer: VA VA |
$11.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.27
|
|
|
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 |
$41.77 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$49.57
|
| Rate for Payer: BCBS Trust/PPO |
$49.85
|
| Rate for Payer: BCBS Trust/PPO |
$37.59
|
| Rate for Payer: BCBS Trust/PPO |
$35.67
|
| Rate for Payer: BCN Commercial |
$49.57
|
| Rate for Payer: BCN Commercial |
$35.67
|
| Rate for Payer: BCN Commercial |
$49.85
|
| Rate for Payer: BCN Commercial |
$37.59
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$51.91
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.29
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Healthscope Commercial |
$54.02
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.31
|
| Rate for Payer: Nomi Health Commercial |
$35.42
|
| Rate for Payer: Nomi Health Commercial |
$37.32
|
| Rate for Payer: Nomi Health Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$49.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.27
|
| Rate for Payer: PHP Commercial |
$51.31
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$37.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.82
|
| Rate for Payer: UHC Core |
$50.12
|
| Rate for Payer: UHC Core |
$50.40
|
| Rate for Payer: UHC Core |
$38.00
|
| Rate for Payer: UHC Core |
$36.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.02
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.49
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$333.73 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: BCBS Trust/PPO |
$396.01
|
| Rate for Payer: BCN Commercial |
$396.01
|
| 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 Commercial |
$407.57
|
| Rate for Payer: Nomi Health Commercial |
$393.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.62
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$417.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.73
|
| 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
|
OP
|
$37.49
|
|
|
Service Code
|
NDC 00527459113
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.61 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Aetna Commercial |
$31.87
|
| Rate for Payer: Aetna Medicare |
$9.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.72
|
| Rate for Payer: BCBS Complete |
$6.94
|
| Rate for Payer: BCBS MAPPO |
$9.37
|
| Rate for Payer: BCBS Trust/PPO |
$30.82
|
| Rate for Payer: BCN Commercial |
$30.82
|
| Rate for Payer: BCN Medicare Advantage |
$9.37
|
| Rate for Payer: Cash Price |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$32.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.37
|
| Rate for Payer: Healthscope Commercial |
$33.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.12
|
| Rate for Payer: Mclaren Medicaid |
$6.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.84
|
| Rate for Payer: Meridian Medicaid |
$6.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.87
|
| Rate for Payer: Nomi Health Commercial |
$30.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.12
|
| Rate for Payer: PACE Senior Care Partners |
$8.90
|
| Rate for Payer: PACE SWMI |
$9.37
|
| Rate for Payer: PHP Commercial |
$31.87
|
| Rate for Payer: PHP Medicare Advantage |
$9.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.62
|
| Rate for Payer: Priority Health Medicare |
$9.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.09
|
| Rate for Payer: Railroad Medicare Medicare |
$9.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.99
|
| Rate for Payer: UHC Core |
$31.30
|
| Rate for Payer: UHC Exchange |
$9.37
|
| Rate for Payer: UHC Medicaid |
$6.61
|
| Rate for Payer: UHC Medicare Advantage |
$9.37
|
| Rate for Payer: UHCCP Medicaid |
$6.61
|
| Rate for Payer: VA VA |
$9.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.12
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$37.49
|
|
|
Service Code
|
NDC 00527459113
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Aetna Commercial |
$31.87
|
| Rate for Payer: BCBS Trust/PPO |
$30.96
|
| Rate for Payer: BCN Commercial |
$30.96
|
| Rate for Payer: Cash Price |
$29.99
|
| Rate for Payer: Cofinity Commercial |
$32.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.99
|
| Rate for Payer: Healthscope Commercial |
$33.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.87
|
| Rate for Payer: Nomi Health Commercial |
$30.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.12
|
| Rate for Payer: PHP Commercial |
$31.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$32.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.99
|
| Rate for Payer: UHC Core |
$31.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.12
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$479.49
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.53 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: Aetna Medicare |
$124.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$149.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$149.84
|
| Rate for Payer: BCBS Complete |
$88.75
|
| Rate for Payer: BCBS MAPPO |
$119.87
|
| Rate for Payer: BCBS Trust/PPO |
$394.19
|
| Rate for Payer: BCN Commercial |
$394.19
|
| Rate for Payer: BCN Medicare Advantage |
$119.87
|
| 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: Health Alliance Plan Medicare Advantage |
$119.87
|
| Rate for Payer: Healthscope Commercial |
$431.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.62
|
| Rate for Payer: Mclaren Medicaid |
$84.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.87
|
| Rate for Payer: Meridian Medicaid |
$88.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$131.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.57
|
| Rate for Payer: Nomi Health Commercial |
$393.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.62
|
| Rate for Payer: PACE Senior Care Partners |
$113.88
|
| Rate for Payer: PACE SWMI |
$119.87
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: PHP Medicare Advantage |
$119.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$417.16
|
| Rate for Payer: Priority Health Medicare |
$121.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.73
|
| Rate for Payer: Railroad Medicare Medicare |
$119.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.95
|
| Rate for Payer: UHC Core |
$400.37
|
| Rate for Payer: UHC Exchange |
$119.87
|
| Rate for Payer: UHC Medicaid |
$84.53
|
| Rate for Payer: UHC Medicare Advantage |
$119.87
|
| Rate for Payer: UHCCP Medicaid |
$84.53
|
| Rate for Payer: VA VA |
$119.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.62
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: BCBS Trust/PPO |
$52.61
|
| Rate for Payer: BCN Commercial |
$52.61
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.77
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.06
|
| Rate for Payer: UHC Core |
$53.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$53.57
|
|
|
Service Code
|
NDC 64380079701
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$48.21 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.74
|
| Rate for Payer: BCBS Complete |
$9.92
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCBS Trust/PPO |
$44.04
|
| Rate for Payer: BCN Commercial |
$44.04
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$46.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$48.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.18
|
| Rate for Payer: Mclaren Medicaid |
$9.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: Meridian Medicaid |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.53
|
| Rate for Payer: Nomi Health Commercial |
$43.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.18
|
| Rate for Payer: PACE Senior Care Partners |
$12.72
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Commercial |
$45.53
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.61
|
| Rate for Payer: Priority Health Medicare |
$13.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.28
|
| Rate for Payer: Railroad Medicare Medicare |
$13.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.14
|
| Rate for Payer: UHC Core |
$44.73
|
| Rate for Payer: UHC Exchange |
$13.39
|
| Rate for Payer: UHC Medicaid |
$9.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.39
|
| Rate for Payer: UHCCP Medicaid |
$9.44
|
| Rate for Payer: VA VA |
$13.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.18
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$16.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.91
|
| Rate for Payer: BCBS Complete |
$11.79
|
| Rate for Payer: BCBS MAPPO |
$15.93
|
| Rate for Payer: BCBS Trust/PPO |
$52.37
|
| Rate for Payer: BCN Commercial |
$52.37
|
| Rate for Payer: BCN Medicare Advantage |
$15.93
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.93
|
| Rate for Payer: Healthscope Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| Rate for Payer: Mclaren Medicaid |
$11.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.72
|
| Rate for Payer: Meridian Medicaid |
$11.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.77
|
| Rate for Payer: PACE Senior Care Partners |
$15.13
|
| Rate for Payer: PACE SWMI |
$15.93
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: PHP Medicare Advantage |
$15.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.42
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.34
|
| Rate for Payer: Railroad Medicare Medicare |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.06
|
| Rate for Payer: UHC Core |
$53.19
|
| Rate for Payer: UHC Exchange |
$15.93
|
| Rate for Payer: UHC Medicaid |
$11.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.93
|
| Rate for Payer: UHCCP Medicaid |
$11.23
|
| Rate for Payer: VA VA |
$15.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$53.57
|
|
|
Service Code
|
NDC 64380079701
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$48.21 |
| Rate for Payer: Aetna Commercial |
$45.53
|
| Rate for Payer: BCBS Trust/PPO |
$44.24
|
| Rate for Payer: BCN Commercial |
$44.24
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Commercial |
$46.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.53
|
| Rate for Payer: Nomi Health Commercial |
$43.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.18
|
| Rate for Payer: PHP Commercial |
$45.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.14
|
| Rate for Payer: UHC Core |
$44.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.18
|
|
|
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 |
$78.90 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: Aetna Medicare |
$116.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$139.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$139.86
|
| Rate for Payer: BCBS Complete |
$82.84
|
| Rate for Payer: BCBS MAPPO |
$111.89
|
| Rate for Payer: BCBS Trust/PPO |
$367.94
|
| Rate for Payer: BCN Commercial |
$367.94
|
| Rate for Payer: BCN Medicare Advantage |
$111.89
|
| 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: Health Alliance Plan Medicare Advantage |
$111.89
|
| Rate for Payer: Healthscope Commercial |
$402.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.67
|
| Rate for Payer: Mclaren Medicaid |
$78.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.48
|
| Rate for Payer: Meridian Medicaid |
$82.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.43
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.67
|
| Rate for Payer: PACE Senior Care Partners |
$106.30
|
| Rate for Payer: PACE SWMI |
$111.89
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: PHP Medicare Advantage |
$111.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.38
|
| Rate for Payer: Priority Health Medicare |
$113.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.50
|
| Rate for Payer: Railroad Medicare Medicare |
$111.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.85
|
| Rate for Payer: UHC Core |
$373.71
|
| Rate for Payer: UHC Exchange |
$111.89
|
| Rate for Payer: UHC Medicaid |
$78.90
|
| Rate for Payer: UHC Medicare Advantage |
$111.89
|
| Rate for Payer: UHCCP Medicaid |
$78.90
|
| Rate for Payer: VA VA |
$111.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.67
|
|
|
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 |
$363.72 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: BCBS Trust/PPO |
$431.61
|
| Rate for Payer: BCN Commercial |
$431.61
|
| 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 Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.94
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$454.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.72
|
| 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 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$27.75
|
|
|
Service Code
|
NDC 09900000790
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Aetna Commercial |
$23.59
|
| Rate for Payer: BCBS Trust/PPO |
$22.92
|
| Rate for Payer: BCN Commercial |
$22.92
|
| 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 Commercial |
$23.59
|
| Rate for Payer: Nomi Health Commercial |
$22.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.81
|
| Rate for Payer: PHP Commercial |
$23.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.31
|
| 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
|
OP
|
$27.75
|
|
|
Service Code
|
NDC 09900000790
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Aetna Commercial |
$23.59
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$6.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.81
|
| Rate for Payer: BCN Commercial |
$22.81
|
| Rate for Payer: BCN Medicare Advantage |
$6.94
|
| 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: Health Alliance Plan Medicare Advantage |
$6.94
|
| Rate for Payer: Healthscope Commercial |
$24.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.81
|
| Rate for Payer: Mclaren Medicaid |
$4.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.59
|
| Rate for Payer: Nomi Health Commercial |
$22.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.81
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.94
|
| Rate for Payer: PHP Commercial |
$23.59
|
| Rate for Payer: PHP Medicare Advantage |
$6.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.42
|
| Rate for Payer: UHC Core |
$23.17
|
| Rate for Payer: UHC Exchange |
$6.94
|
| Rate for Payer: UHC Medicaid |
$4.89
|
| Rate for Payer: UHC Medicare Advantage |
$6.94
|
| Rate for Payer: UHCCP Medicaid |
$4.89
|
| Rate for Payer: VA VA |
$6.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.81
|
|
|
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 |
$311.50 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: BCBS Trust/PPO |
$369.64
|
| Rate for Payer: BCN Commercial |
$369.64
|
| 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 Commercial |
$380.43
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.67
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$389.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.50
|
| 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
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.53 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: Aetna Medicare |
$56.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.30
|
| Rate for Payer: BCBS Complete |
$40.45
|
| Rate for Payer: BCBS MAPPO |
$54.64
|
| Rate for Payer: BCBS Trust/PPO |
$179.67
|
| Rate for Payer: BCN Commercial |
$179.67
|
| Rate for Payer: BCN Medicare Advantage |
$54.64
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.64
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Mclaren Medicaid |
$38.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.37
|
| Rate for Payer: Meridian Medicaid |
$40.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PACE Senior Care Partners |
$51.91
|
| Rate for Payer: PACE SWMI |
$54.64
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: PHP Medicare Advantage |
$54.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.14
|
| Rate for Payer: Priority Health Medicare |
$55.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.11
|
| Rate for Payer: Railroad Medicare Medicare |
$54.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: UHC Exchange |
$54.64
|
| Rate for Payer: UHC Medicaid |
$38.53
|
| Rate for Payer: UHC Medicare Advantage |
$54.64
|
| Rate for Payer: UHCCP Medicaid |
$38.53
|
| Rate for Payer: VA VA |
$54.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.11 |
| Max. Negotiated Rate |
$196.69 |
| Rate for Payer: Aetna Commercial |
$185.77
|
| Rate for Payer: BCBS Trust/PPO |
$180.50
|
| Rate for Payer: BCN Commercial |
$180.50
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$187.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$196.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: PHP Commercial |
$185.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$190.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.32
|
| Rate for Payer: UHC Core |
$182.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.91
|
|
|
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 |
$92.13 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: Aetna Medicare |
$135.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.31
|
| Rate for Payer: BCBS Complete |
$96.73
|
| Rate for Payer: BCBS MAPPO |
$130.65
|
| Rate for Payer: BCBS Trust/PPO |
$429.62
|
| Rate for Payer: BCN Commercial |
$429.62
|
| Rate for Payer: BCN Medicare Advantage |
$130.65
|
| 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: Health Alliance Plan Medicare Advantage |
$130.65
|
| Rate for Payer: Healthscope Commercial |
$470.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.94
|
| Rate for Payer: Mclaren Medicaid |
$92.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.18
|
| Rate for Payer: Meridian Medicaid |
$96.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.94
|
| Rate for Payer: PACE Senior Care Partners |
$124.12
|
| Rate for Payer: PACE SWMI |
$130.65
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: PHP Medicare Advantage |
$130.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$454.65
|
| Rate for Payer: Priority Health Medicare |
$131.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.72
|
| Rate for Payer: Railroad Medicare Medicare |
$130.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.88
|
| Rate for Payer: UHC Core |
$436.36
|
| Rate for Payer: UHC Exchange |
$130.65
|
| Rate for Payer: UHC Medicaid |
$92.13
|
| Rate for Payer: UHC Medicare Advantage |
$130.65
|
| Rate for Payer: UHCCP Medicaid |
$92.13
|
| Rate for Payer: VA VA |
$130.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.94
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$63.60
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: Aetna Medicare |
$16.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.88
|
| Rate for Payer: BCBS Complete |
$11.77
|
| Rate for Payer: BCBS MAPPO |
$15.90
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$52.29
|
| Rate for Payer: BCN Medicare Advantage |
$15.90
|
| Rate for Payer: Cash Price |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$57.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.70
|
| Rate for Payer: Mclaren Medicaid |
$11.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.70
|
| Rate for Payer: Meridian Medicaid |
$11.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.06
|
| Rate for Payer: Nomi Health Commercial |
$52.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.70
|
| Rate for Payer: PACE Senior Care Partners |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.90
|
| Rate for Payer: PHP Commercial |
$54.06
|
| Rate for Payer: PHP Medicare Advantage |
$15.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.33
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.27
|
| Rate for Payer: Railroad Medicare Medicare |
$15.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.97
|
| Rate for Payer: UHC Core |
$53.11
|
| Rate for Payer: UHC Exchange |
$15.90
|
| Rate for Payer: UHC Medicaid |
$11.21
|
| Rate for Payer: UHC Medicare Advantage |
$15.90
|
| Rate for Payer: UHCCP Medicaid |
$11.21
|
| Rate for Payer: VA VA |
$15.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.70
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$82.61
|
|
|
Service Code
|
NDC 64380079901
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$74.35 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.82
|
| Rate for Payer: BCBS Complete |
$15.29
|
| Rate for Payer: BCBS MAPPO |
$20.65
|
| Rate for Payer: BCBS Trust/PPO |
$67.91
|
| Rate for Payer: BCN Commercial |
$67.91
|
| Rate for Payer: BCN Medicare Advantage |
$20.65
|
| Rate for Payer: Cash Price |
$66.09
|
| Rate for Payer: Cofinity Commercial |
$71.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.65
|
| Rate for Payer: Healthscope Commercial |
$74.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Mclaren Medicaid |
$14.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.69
|
| Rate for Payer: Meridian Medicaid |
$15.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$67.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.96
|
| Rate for Payer: PACE Senior Care Partners |
$19.62
|
| Rate for Payer: PACE SWMI |
$20.65
|
| Rate for Payer: PHP Commercial |
$70.22
|
| Rate for Payer: PHP Medicare Advantage |
$20.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.87
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.70
|
| Rate for Payer: UHC Core |
$68.98
|
| Rate for Payer: UHC Exchange |
$20.65
|
| Rate for Payer: UHC Medicaid |
$14.56
|
| Rate for Payer: UHC Medicare Advantage |
$20.65
|
| Rate for Payer: UHCCP Medicaid |
$14.56
|
| Rate for Payer: VA VA |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$82.61
|
|
|
Service Code
|
NDC 64380079901
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$74.35 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: BCBS Trust/PPO |
$68.23
|
| Rate for Payer: BCN Commercial |
$68.23
|
| Rate for Payer: Cash Price |
$66.09
|
| Rate for Payer: Cofinity Commercial |
$71.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.09
|
| Rate for Payer: Healthscope Commercial |
$74.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$67.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.96
|
| Rate for Payer: PHP Commercial |
$70.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.70
|
| Rate for Payer: UHC Core |
$68.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.96
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$63.60
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$57.24 |
| Rate for Payer: Aetna Commercial |
$54.06
|
| Rate for Payer: BCBS Trust/PPO |
$52.53
|
| Rate for Payer: BCN Commercial |
$52.53
|
| Rate for Payer: Cash Price |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$57.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.06
|
| Rate for Payer: Nomi Health Commercial |
$52.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.70
|
| Rate for Payer: PHP Commercial |
$54.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$55.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.97
|
| Rate for Payer: UHC Core |
$53.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.70
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.14 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: Aetna Medicare |
$135.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$163.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$163.32
|
| Rate for Payer: BCBS Complete |
$96.74
|
| Rate for Payer: BCBS MAPPO |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$429.65
|
| Rate for Payer: BCN Commercial |
$429.65
|
| Rate for Payer: BCN Medicare Advantage |
$130.66
|
| 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: Health Alliance Plan Medicare Advantage |
$130.66
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.97
|
| Rate for Payer: Mclaren Medicaid |
$92.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.19
|
| Rate for Payer: Meridian Medicaid |
$96.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.24
|
| Rate for Payer: Nomi Health Commercial |
$428.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.97
|
| Rate for Payer: PACE Senior Care Partners |
$124.12
|
| Rate for Payer: PACE SWMI |
$130.66
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: PHP Medicare Advantage |
$130.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$454.69
|
| Rate for Payer: Priority Health Medicare |
$131.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.75
|
| Rate for Payer: Railroad Medicare Medicare |
$130.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.91
|
| Rate for Payer: UHC Core |
$436.40
|
| Rate for Payer: UHC Exchange |
$130.66
|
| Rate for Payer: UHC Medicaid |
$92.14
|
| Rate for Payer: UHC Medicare Advantage |
$130.66
|
| Rate for Payer: UHCCP Medicaid |
$92.14
|
| Rate for Payer: VA VA |
$130.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$363.75 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: BCBS Trust/PPO |
$431.64
|
| Rate for Payer: BCN Commercial |
$431.64
|
| 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 Commercial |
$444.24
|
| Rate for Payer: Nomi Health Commercial |
$428.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.97
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$454.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.75
|
| 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
|
|
