|
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 |
$10.26 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Medicare |
$11.48
|
| 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 |
$18.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.80
|
| 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 |
$17.28
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS Complete |
$24.14
|
| Rate for Payer: BCBS Complete |
$24.01
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$11.04
|
| Rate for Payer: BCBS MAPPO |
$15.09
|
| Rate for Payer: BCBS MAPPO |
$15.00
|
| Rate for Payer: BCBS Trust/PPO |
$35.51
|
| Rate for Payer: BCBS Trust/PPO |
$49.62
|
| Rate for Payer: BCBS Trust/PPO |
$36.31
|
| Rate for Payer: BCBS Trust/PPO |
$49.34
|
| Rate for Payer: BCN Commercial |
$33.58
|
| Rate for Payer: BCN Commercial |
$46.67
|
| Rate for Payer: BCN Commercial |
$34.34
|
| Rate for Payer: BCN Commercial |
$46.93
|
| Rate for Payer: BCN Medicare Advantage |
$11.04
|
| Rate for Payer: BCN Medicare Advantage |
$15.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: BCN Medicare Advantage |
$15.00
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$48.29
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$35.34
|
| Rate for Payer: Cofinity Commercial |
$51.91
|
| Rate for Payer: Cofinity Commercial |
$37.99
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.29
|
| 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 |
$11.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.00
|
| 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 |
$39.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.59
|
| 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 |
$15.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.02
|
| Rate for Payer: Nomi Health Commercial |
$49.22
|
| Rate for Payer: Nomi Health Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$35.42
|
| Rate for Payer: Nomi Health Commercial |
$36.22
|
| Rate for Payer: PACE Senior Care Partners |
$10.26
|
| 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 |
$10.49
|
| Rate for Payer: PACE SWMI |
$11.04
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PACE SWMI |
$15.00
|
| Rate for Payer: PACE SWMI |
$15.09
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$51.31
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Medicare Advantage |
$11.04
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: PHP Medicare Advantage |
$15.09
|
| Rate for Payer: PHP Medicare Advantage |
$15.00
|
| 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 |
$39.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| Rate for Payer: Priority Health HMO/PPO |
$38.43
|
| Rate for Payer: Priority Health HMO/PPO |
$52.51
|
| Rate for Payer: Priority Health HMO/PPO |
$52.22
|
| Rate for Payer: Priority Health HMO/PPO |
$37.58
|
| Rate for Payer: Priority Health Medicare |
$15.16
|
| Rate for Payer: Priority Health Medicare |
$10.91
|
| Rate for Payer: Priority Health Medicare |
$11.15
|
| Rate for Payer: Priority Health Medicare |
$15.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.94
|
| Rate for Payer: Railroad Medicare Medicare |
$11.04
|
| Rate for Payer: Railroad Medicare Medicare |
$15.00
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$15.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.87
|
| Rate for Payer: UHC Core |
$36.06
|
| Rate for Payer: UHC Core |
$50.40
|
| Rate for Payer: UHC Core |
$36.88
|
| Rate for Payer: UHC Core |
$50.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.04
|
| Rate for Payer: UHC Exchange |
$15.09
|
| Rate for Payer: UHC Exchange |
$11.04
|
| Rate for Payer: UHC Exchange |
$10.80
|
| Rate for Payer: UHC Exchange |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Medicare Advantage |
$15.00
|
| Rate for Payer: UHC Medicare Advantage |
$11.04
|
| Rate for Payer: VA VA |
$11.04
|
| Rate for Payer: VA VA |
$15.09
|
| Rate for Payer: VA VA |
$15.00
|
| Rate for Payer: VA VA |
$10.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.13
|
| 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 |
$45.02
|
|
|
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 |
$39.01 |
| Max. Negotiated Rate |
$54.02 |
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$48.99
|
| Rate for Payer: BCBS Trust/PPO |
$49.27
|
| Rate for Payer: BCBS Trust/PPO |
$36.06
|
| Rate for Payer: BCBS Trust/PPO |
$35.26
|
| Rate for Payer: BCN Commercial |
$46.38
|
| Rate for Payer: BCN Commercial |
$33.38
|
| Rate for Payer: BCN Commercial |
$46.65
|
| Rate for Payer: BCN Commercial |
$34.13
|
| Rate for Payer: Cash Price |
$35.34
|
| 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 |
$37.99
|
| 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 |
$35.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.29
|
| Rate for Payer: Healthscope Commercial |
$54.32
|
| Rate for Payer: Healthscope Commercial |
$39.75
|
| 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 |
$33.13
|
| 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 |
$37.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.31
|
| Rate for Payer: Nomi Health Commercial |
$35.42
|
| Rate for Payer: Nomi Health Commercial |
$36.22
|
| Rate for Payer: Nomi Health Commercial |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$49.22
|
| Rate for Payer: PHP Commercial |
$37.54
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$51.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.07
|
| 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 HMO/PPO |
$52.22
|
| Rate for Payer: Priority Health HMO/PPO |
$52.51
|
| Rate for Payer: Priority Health HMO/PPO |
$37.58
|
| Rate for Payer: Priority Health HMO/PPO |
$38.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.94
|
| 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) |
$38.87
|
| 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 |
$36.88
|
| 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 |
$33.13
|
| 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 |
$311.67 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: BCBS Trust/PPO |
$391.41
|
| 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 Commercial |
$407.57
|
| Rate for Payer: Nomi Health Commercial |
$393.18
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.67
|
| Rate for Payer: Priority Health HMO/PPO |
$417.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.26
|
| 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
|
$39.17
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: Aetna Medicare |
$10.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.24
|
| Rate for Payer: BCBS Complete |
$15.67
|
| Rate for Payer: BCBS MAPPO |
$9.79
|
| Rate for Payer: BCBS Trust/PPO |
$32.20
|
| Rate for Payer: BCN Commercial |
$30.45
|
| Rate for Payer: BCN Medicare Advantage |
$9.79
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$33.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.79
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: PACE Senior Care Partners |
$9.30
|
| Rate for Payer: PACE SWMI |
$9.79
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: PHP Medicare Advantage |
$9.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health HMO/PPO |
$34.08
|
| Rate for Payer: Priority Health Medicare |
$9.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: Railroad Medicare Medicare |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.47
|
| Rate for Payer: UHC Core |
$32.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.79
|
| Rate for Payer: UHC Exchange |
$9.79
|
| Rate for Payer: UHC Medicare Advantage |
$9.79
|
| Rate for Payer: VA VA |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.38
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$39.17
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Commercial |
$33.29
|
| Rate for Payer: BCBS Trust/PPO |
$31.97
|
| Rate for Payer: BCN Commercial |
$30.27
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Cofinity Commercial |
$33.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Healthscope Commercial |
$35.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: PHP Commercial |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health HMO/PPO |
$34.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.47
|
| Rate for Payer: UHC Core |
$32.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.38
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$479.49
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.88 |
| 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 |
$191.80
|
| Rate for Payer: BCBS MAPPO |
$119.87
|
| Rate for Payer: BCBS Trust/PPO |
$394.19
|
| Rate for Payer: BCN Commercial |
$372.80
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.57
|
| Rate for Payer: Nomi Health Commercial |
$393.18
|
| 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 Cigna Priority Health |
$311.67
|
| Rate for Payer: Priority Health HMO/PPO |
$417.16
|
| Rate for Payer: Priority Health Medicare |
$121.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$321.26
|
| 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 Dual Complete DSNP |
$119.87
|
| Rate for Payer: UHC Exchange |
$119.87
|
| Rate for Payer: UHC Medicare Advantage |
$119.87
|
| Rate for Payer: VA VA |
$119.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.62
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$60.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.14
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS MAPPO |
$57.71
|
| Rate for Payer: BCBS Trust/PPO |
$189.78
|
| Rate for Payer: BCN Commercial |
$179.49
|
| Rate for Payer: BCN Medicare Advantage |
$57.71
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.71
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PACE Senior Care Partners |
$54.83
|
| Rate for Payer: PACE SWMI |
$57.71
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Medicare |
$58.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.71
|
| Rate for Payer: UHC Exchange |
$57.71
|
| Rate for Payer: UHC Medicare Advantage |
$57.71
|
| Rate for Payer: VA VA |
$57.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
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 |
$18.04 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Aetna Commercial |
$23.59
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| 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 Commercial |
$23.59
|
| Rate for Payer: Nomi Health Commercial |
$22.76
|
| Rate for Payer: PHP Commercial |
$23.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.04
|
| Rate for Payer: Priority Health HMO/PPO |
$24.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.59
|
| 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 |
$6.59 |
| Max. Negotiated Rate |
$24.98 |
| Rate for Payer: Aetna Commercial |
$23.59
|
| Rate for Payer: Aetna Medicare |
$7.22
|
| 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 |
$11.10
|
| Rate for Payer: BCBS MAPPO |
$6.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.81
|
| Rate for Payer: BCN Commercial |
$21.58
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.59
|
| Rate for Payer: Nomi Health Commercial |
$22.76
|
| 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 Cigna Priority Health |
$18.04
|
| Rate for Payer: Priority Health HMO/PPO |
$24.14
|
| Rate for Payer: Priority Health Medicare |
$7.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.59
|
| 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 Dual Complete DSNP |
$6.94
|
| Rate for Payer: UHC Exchange |
$6.94
|
| Rate for Payer: UHC Medicare Advantage |
$6.94
|
| 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 |
$290.91 |
| Max. Negotiated Rate |
$402.80 |
| Rate for Payer: Aetna Commercial |
$380.43
|
| Rate for Payer: BCBS Trust/PPO |
$365.34
|
| 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 Commercial |
$380.43
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PHP Commercial |
$380.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.91
|
| Rate for Payer: Priority Health HMO/PPO |
$389.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.87
|
| 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
|
$522.59
|
|
|
Service Code
|
NDC 00004082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.12 |
| 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 |
$209.04
|
| Rate for Payer: BCBS MAPPO |
$130.65
|
| Rate for Payer: BCBS Trust/PPO |
$429.62
|
| Rate for Payer: BCN Commercial |
$406.31
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| 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 Cigna Priority Health |
$339.68
|
| Rate for Payer: Priority Health HMO/PPO |
$454.65
|
| Rate for Payer: Priority Health Medicare |
$131.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.14
|
| 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 Dual Complete DSNP |
$130.65
|
| Rate for Payer: UHC Exchange |
$130.65
|
| Rate for Payer: UHC Medicare Advantage |
$130.65
|
| Rate for Payer: VA VA |
$130.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.94
|
|
|
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 |
$106.30 |
| 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 |
$179.02
|
| Rate for Payer: BCBS MAPPO |
$111.89
|
| Rate for Payer: BCBS Trust/PPO |
$367.94
|
| Rate for Payer: BCN Commercial |
$347.98
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$128.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.43
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| 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 Cigna Priority Health |
$290.91
|
| Rate for Payer: Priority Health HMO/PPO |
$389.38
|
| Rate for Payer: Priority Health Medicare |
$113.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.87
|
| 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 Dual Complete DSNP |
$111.89
|
| Rate for Payer: UHC Exchange |
$111.89
|
| Rate for Payer: UHC Medicare Advantage |
$111.89
|
| 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 |
$339.68 |
| Max. Negotiated Rate |
$470.33 |
| Rate for Payer: Aetna Commercial |
$444.20
|
| Rate for Payer: BCBS Trust/PPO |
$426.59
|
| 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 Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: PHP Commercial |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.68
|
| Rate for Payer: Priority Health HMO/PPO |
$454.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.14
|
| 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
|
$230.85
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: BCBS Trust/PPO |
$188.44
|
| Rate for Payer: BCN Commercial |
$178.40
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO |
$200.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$192.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.71 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: BCBS Trust/PPO |
$426.62
|
| 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 Commercial |
$444.24
|
| Rate for Payer: Nomi Health Commercial |
$428.56
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.71
|
| Rate for Payer: Priority Health HMO/PPO |
$454.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.16
|
| 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
|
OP
|
$82.61
|
|
|
Service Code
|
NDC 64380079901
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.62 |
| 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 |
$33.04
|
| Rate for Payer: BCBS MAPPO |
$20.65
|
| Rate for Payer: BCBS Trust/PPO |
$67.91
|
| Rate for Payer: BCN Commercial |
$64.23
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$67.74
|
| 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 Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health HMO/PPO |
$71.87
|
| Rate for Payer: Priority Health Medicare |
$20.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.35
|
| 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 Dual Complete DSNP |
$20.65
|
| Rate for Payer: UHC Exchange |
$20.65
|
| Rate for Payer: UHC Medicare Advantage |
$20.65
|
| 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 |
$53.70 |
| Max. Negotiated Rate |
$74.35 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: BCBS Trust/PPO |
$67.43
|
| Rate for Payer: BCN Commercial |
$63.84
|
| 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: PHP Commercial |
$70.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.70
|
| Rate for Payer: Priority Health HMO/PPO |
$71.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.35
|
| 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
|
$53.96
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Aetna Commercial |
$45.87
|
| Rate for Payer: BCBS Trust/PPO |
$44.05
|
| Rate for Payer: BCN Commercial |
$41.70
|
| Rate for Payer: Cash Price |
$43.17
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.17
|
| Rate for Payer: Healthscope Commercial |
$48.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.87
|
| Rate for Payer: Nomi Health Commercial |
$44.25
|
| Rate for Payer: PHP Commercial |
$45.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: Priority Health HMO/PPO |
$46.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.48
|
| Rate for Payer: UHC Core |
$45.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.47
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.12 |
| 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 |
$209.05
|
| Rate for Payer: BCBS MAPPO |
$130.66
|
| Rate for Payer: BCBS Trust/PPO |
$429.65
|
| Rate for Payer: BCN Commercial |
$406.34
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.24
|
| Rate for Payer: Nomi Health Commercial |
$428.56
|
| 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 Cigna Priority Health |
$339.71
|
| Rate for Payer: Priority Health HMO/PPO |
$454.69
|
| Rate for Payer: Priority Health Medicare |
$131.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.16
|
| 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 Dual Complete DSNP |
$130.66
|
| Rate for Payer: UHC Exchange |
$130.66
|
| Rate for Payer: UHC Medicare Advantage |
$130.66
|
| Rate for Payer: VA VA |
$130.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$53.96
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Aetna Commercial |
$45.87
|
| Rate for Payer: Aetna Medicare |
$14.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.86
|
| Rate for Payer: BCBS Complete |
$21.58
|
| Rate for Payer: BCBS MAPPO |
$13.49
|
| Rate for Payer: BCBS Trust/PPO |
$44.36
|
| Rate for Payer: BCN Commercial |
$41.95
|
| Rate for Payer: BCN Medicare Advantage |
$13.49
|
| Rate for Payer: Cash Price |
$43.17
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.49
|
| Rate for Payer: Healthscope Commercial |
$48.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.87
|
| Rate for Payer: Nomi Health Commercial |
$44.25
|
| Rate for Payer: PACE Senior Care Partners |
$12.82
|
| Rate for Payer: PACE SWMI |
$13.49
|
| Rate for Payer: PHP Commercial |
$45.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: Priority Health HMO/PPO |
$46.95
|
| Rate for Payer: Priority Health Medicare |
$13.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.15
|
| Rate for Payer: Railroad Medicare Medicare |
$13.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.48
|
| Rate for Payer: UHC Core |
$45.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.49
|
| Rate for Payer: UHC Exchange |
$13.49
|
| Rate for Payer: UHC Medicare Advantage |
$13.49
|
| Rate for Payer: VA VA |
$13.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.47
|
|
|
OSTECTOMY, CALCANEUS;
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28118
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENING OR ANGULAR CORRECTION, METATARSAL; OTHER THAN FIRST METATARSAL, EACH
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28308
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
IP
|
$903.17
|
|
|
Service Code
|
NDC 62584081301
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$812.85 |
| Rate for Payer: Aetna Commercial |
$767.69
|
| Rate for Payer: BCBS Trust/PPO |
$737.26
|
| Rate for Payer: BCN Commercial |
$697.97
|
| Rate for Payer: Cash Price |
$722.54
|
| Rate for Payer: Cofinity Commercial |
$776.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.54
|
| Rate for Payer: Healthscope Commercial |
$812.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.69
|
| Rate for Payer: Nomi Health Commercial |
$740.60
|
| Rate for Payer: PHP Commercial |
$767.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.06
|
| Rate for Payer: Priority Health HMO/PPO |
$785.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$605.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$794.79
|
| Rate for Payer: UHC Core |
$754.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.38
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$903.17
|
|
|
Service Code
|
NDC 62584081301
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.50 |
| Max. Negotiated Rate |
$812.85 |
| Rate for Payer: Aetna Commercial |
$767.69
|
| Rate for Payer: Aetna Medicare |
$234.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$282.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$282.24
|
| Rate for Payer: BCBS Complete |
$361.27
|
| Rate for Payer: BCBS MAPPO |
$225.79
|
| Rate for Payer: BCBS Trust/PPO |
$742.50
|
| Rate for Payer: BCN Commercial |
$702.21
|
| Rate for Payer: BCN Medicare Advantage |
$225.79
|
| Rate for Payer: Cash Price |
$722.54
|
| Rate for Payer: Cofinity Commercial |
$776.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.79
|
| Rate for Payer: Healthscope Commercial |
$812.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$677.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.69
|
| Rate for Payer: Nomi Health Commercial |
$740.60
|
| Rate for Payer: PACE Senior Care Partners |
$214.50
|
| Rate for Payer: PACE SWMI |
$225.79
|
| Rate for Payer: PHP Commercial |
$767.69
|
| Rate for Payer: PHP Medicare Advantage |
$225.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.06
|
| Rate for Payer: Priority Health HMO/PPO |
$785.76
|
| Rate for Payer: Priority Health Medicare |
$228.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$605.12
|
| Rate for Payer: Railroad Medicare Medicare |
$225.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$794.79
|
| Rate for Payer: UHC Core |
$754.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.79
|
| Rate for Payer: UHC Exchange |
$225.79
|
| Rate for Payer: UHC Medicare Advantage |
$225.79
|
| Rate for Payer: VA VA |
$225.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$677.38
|
|
|
OXAZEPAM 15 MG CAPSULE
|
Facility
|
OP
|
$9.04
|
|
|
Service Code
|
NDC 62584081311
|
| Hospital Charge Code |
5931
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$8.14 |
| Rate for Payer: Aetna Commercial |
$7.68
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.82
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$2.26
|
| Rate for Payer: BCBS Trust/PPO |
$7.43
|
| Rate for Payer: BCN Commercial |
$7.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.26
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$7.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$7.41
|
| Rate for Payer: PACE Senior Care Partners |
$2.15
|
| Rate for Payer: PACE SWMI |
$2.26
|
| Rate for Payer: PHP Commercial |
$7.68
|
| Rate for Payer: PHP Medicare Advantage |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.88
|
| Rate for Payer: Priority Health HMO/PPO |
$7.86
|
| Rate for Payer: Priority Health Medicare |
$2.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.96
|
| Rate for Payer: UHC Core |
$7.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.26
|
| Rate for Payer: UHC Exchange |
$2.26
|
| Rate for Payer: UHC Medicare Advantage |
$2.26
|
| Rate for Payer: VA VA |
$2.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.78
|
|
