|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,887.66
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,670.57 |
| Max. Negotiated Rate |
$11,598.89 |
| Rate for Payer: Aetna American Axle |
$8,376.98
|
| Rate for Payer: Aetna Commercial |
$10,954.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,376.98
|
| Rate for Payer: Cash Price |
$10,310.13
|
| Rate for Payer: Cofinity Advantage |
$9,021.36
|
| Rate for Payer: Cofinity Commercial |
$11,083.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,310.13
|
| Rate for Payer: Healthscope Commercial |
$11,598.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,021.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,665.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,954.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,665.75
|
| Rate for Payer: PHP Commercial |
$10,954.51
|
| Rate for Payer: Priority Health SBD |
$8,119.23
|
| Rate for Payer: UMR Bronson Commercial |
$5,670.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,665.75
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$10,674.63
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,696.84 |
| Max. Negotiated Rate |
$9,607.17 |
| Rate for Payer: Aetna American Axle |
$6,938.51
|
| Rate for Payer: Aetna American Axle |
$2,312.84
|
| Rate for Payer: Aetna Commercial |
$9,073.44
|
| Rate for Payer: Aetna Commercial |
$3,024.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,938.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,312.84
|
| Rate for Payer: Cash Price |
$8,539.70
|
| Rate for Payer: Cash Price |
$2,846.57
|
| Rate for Payer: Cofinity Advantage |
$2,490.75
|
| Rate for Payer: Cofinity Advantage |
$7,472.24
|
| Rate for Payer: Cofinity Commercial |
$3,060.06
|
| Rate for Payer: Cofinity Commercial |
$9,180.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,539.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,846.57
|
| Rate for Payer: Healthscope Commercial |
$9,607.17
|
| Rate for Payer: Healthscope Commercial |
$3,202.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,490.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,472.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,005.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,668.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,073.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,024.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,005.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,668.66
|
| Rate for Payer: PHP Commercial |
$9,073.44
|
| Rate for Payer: PHP Commercial |
$3,024.48
|
| Rate for Payer: Priority Health SBD |
$2,241.67
|
| Rate for Payer: Priority Health SBD |
$6,725.02
|
| Rate for Payer: UMR Bronson Commercial |
$4,696.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,565.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,005.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,668.66
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,558.21
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$3,202.39 |
| Rate for Payer: Aetna American Axle |
$2,312.84
|
| Rate for Payer: Aetna American Axle |
$6,938.51
|
| Rate for Payer: Aetna Commercial |
$9,073.44
|
| Rate for Payer: Aetna Commercial |
$3,024.48
|
| Rate for Payer: Aetna Medicare |
$29.71
|
| Rate for Payer: Aetna Medicare |
$29.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,938.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,312.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.71
|
| Rate for Payer: BCBS Complete |
$15.69
|
| Rate for Payer: BCBS Complete |
$15.69
|
| Rate for Payer: BCBS MAPPO |
$28.57
|
| Rate for Payer: BCBS MAPPO |
$28.57
|
| Rate for Payer: BCBS Trust/PPO |
$92.30
|
| Rate for Payer: BCBS Trust/PPO |
$92.30
|
| Rate for Payer: BCN Commercial |
$92.30
|
| Rate for Payer: BCN Commercial |
$92.30
|
| Rate for Payer: BCN Medicare Advantage |
$28.57
|
| Rate for Payer: BCN Medicare Advantage |
$28.57
|
| Rate for Payer: Cash Price |
$8,539.70
|
| Rate for Payer: Cash Price |
$2,846.57
|
| Rate for Payer: Cash Price |
$2,846.57
|
| Rate for Payer: Cash Price |
$8,539.70
|
| Rate for Payer: Cofinity Advantage |
$2,490.75
|
| Rate for Payer: Cofinity Advantage |
$7,472.24
|
| Rate for Payer: Cofinity Commercial |
$9,180.18
|
| Rate for Payer: Cofinity Commercial |
$3,060.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,539.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,846.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.57
|
| Rate for Payer: Healthscope Commercial |
$9,607.17
|
| Rate for Payer: Healthscope Commercial |
$3,202.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,490.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,472.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,005.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,668.66
|
| Rate for Payer: Mclaren Medicaid |
$28.57
|
| Rate for Payer: Mclaren Medicaid |
$28.57
|
| Rate for Payer: Mclaren Medicare |
$28.57
|
| Rate for Payer: Mclaren Medicare |
$28.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.00
|
| Rate for Payer: Meridian Medicaid |
$30.00
|
| Rate for Payer: Meridian Medicaid |
$30.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,073.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,024.48
|
| Rate for Payer: Nomi Health Commercial |
$85.71
|
| Rate for Payer: Nomi Health Commercial |
$85.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,668.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,005.97
|
| Rate for Payer: PACE Medicare |
$27.14
|
| Rate for Payer: PACE Medicare |
$27.14
|
| Rate for Payer: PACE SWMI |
$28.57
|
| Rate for Payer: PACE SWMI |
$28.57
|
| Rate for Payer: PHP Commercial |
$9,073.44
|
| Rate for Payer: PHP Commercial |
$3,024.48
|
| Rate for Payer: PHP Medicare Advantage |
$28.57
|
| Rate for Payer: PHP Medicare Advantage |
$28.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90.45
|
| Rate for Payer: Priority Health Medicare |
$28.57
|
| Rate for Payer: Priority Health Medicare |
$28.57
|
| Rate for Payer: Priority Health SBD |
$6,725.02
|
| Rate for Payer: Priority Health SBD |
$2,241.67
|
| Rate for Payer: Priority Health Tiered Network |
$72.36
|
| Rate for Payer: Priority Health Tiered Network |
$72.36
|
| Rate for Payer: Railroad Medicare Medicare |
$28.57
|
| Rate for Payer: Railroad Medicare Medicare |
$28.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.98
|
| Rate for Payer: UHC Core |
$46.98
|
| Rate for Payer: UHC Core |
$46.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.57
|
| Rate for Payer: UHC Exchange |
$46.98
|
| Rate for Payer: UHC Exchange |
$46.98
|
| Rate for Payer: UHC Medicaid |
$14.94
|
| Rate for Payer: UHC Medicaid |
$14.94
|
| Rate for Payer: UHCCP Medicaid |
$14.94
|
| Rate for Payer: UHCCP Medicaid |
$14.94
|
| Rate for Payer: UMR Bronson Commercial |
$3,949.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,316.54
|
| Rate for Payer: VA VA |
$28.57
|
| Rate for Payer: VA VA |
$28.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,668.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,005.97
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$43.19
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna American Axle |
$28.07
|
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Advantage |
$31.86
|
| Rate for Payer: Cofinity Advantage |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: UMR Bronson Commercial |
$19.00
|
| Rate for Payer: UMR Bronson Commercial |
$20.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
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 |
$10.54 |
| Max. Negotiated Rate |
$38.87 |
| Rate for Payer: Aetna American Axle |
$28.07
|
| Rate for Payer: Aetna American Axle |
$29.58
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$38.68
|
| Rate for Payer: Aetna Medicare |
$21.59
|
| Rate for Payer: Aetna Medicare |
$22.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.58
|
| Rate for Payer: BCBS Complete |
$18.20
|
| Rate for Payer: BCBS Complete |
$17.28
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cofinity Advantage |
$30.23
|
| Rate for Payer: Cofinity Advantage |
$31.86
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| 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 |
$36.41
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.39
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$38.68
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: Priority Health SBD |
$28.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.54
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Exchange |
$10.54
|
| Rate for Payer: UHC Exchange |
$10.54
|
| Rate for Payer: UMR Bronson Commercial |
$15.98
|
| Rate for Payer: UMR Bronson Commercial |
$16.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.13
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$34,492.18
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$13,277.00 |
| Max. Negotiated Rate |
$34,492.18 |
| Rate for Payer: Aetna Medicare |
$14,534.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,469.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,469.74
|
| Rate for Payer: BCBS MAPPO |
$13,975.79
|
| Rate for Payer: BCBS Trust/PPO |
$34,492.18
|
| Rate for Payer: BCN Commercial |
$34,492.18
|
| Rate for Payer: BCN Medicare Advantage |
$13,975.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,975.79
|
| Rate for Payer: Mclaren Medicare |
$13,975.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,674.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,072.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,373.37
|
| Rate for Payer: Nomi Health Commercial |
$20,643.87
|
| Rate for Payer: PACE Medicare |
$13,277.00
|
| Rate for Payer: PACE SWMI |
$13,975.79
|
| Rate for Payer: PHP Medicare Advantage |
$13,975.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,800.26
|
| Rate for Payer: Priority Health Medicare |
$13,975.79
|
| Rate for Payer: Priority Health Tiered Network |
$20,640.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13,975.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,084.89
|
| Rate for Payer: UHC Core |
$21,823.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,975.79
|
| Rate for Payer: UHC Exchange |
$17,822.54
|
| Rate for Payer: VA VA |
$13,975.79
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$47,797.68
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$23,502.44 |
| Max. Negotiated Rate |
$47,797.68 |
| Rate for Payer: Aetna Medicare |
$25,728.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,924.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,924.26
|
| Rate for Payer: BCBS MAPPO |
$24,739.41
|
| Rate for Payer: BCBS Trust/PPO |
$47,797.68
|
| Rate for Payer: BCN Commercial |
$47,797.68
|
| Rate for Payer: BCN Medicare Advantage |
$24,739.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,739.41
|
| Rate for Payer: Mclaren Medicare |
$24,739.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,976.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,450.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,213.35
|
| Rate for Payer: Nomi Health Commercial |
$37,247.46
|
| Rate for Payer: PACE Medicare |
$23,502.44
|
| Rate for Payer: PACE SWMI |
$24,739.41
|
| Rate for Payer: PHP Medicare Advantage |
$24,739.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46,551.07
|
| Rate for Payer: Priority Health Medicare |
$24,739.41
|
| Rate for Payer: Priority Health Tiered Network |
$37,240.85
|
| Rate for Payer: Railroad Medicare Medicare |
$24,739.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47,064.62
|
| Rate for Payer: UHC Core |
$39,375.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,739.41
|
| Rate for Payer: UHC Exchange |
$32,156.97
|
| Rate for Payer: VA VA |
$24,739.41
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$31,381.98
|
|
|
Service Code
|
MSDRG 621
|
| Min. Negotiated Rate |
$12,546.90 |
| Max. Negotiated Rate |
$31,381.98 |
| Rate for Payer: Aetna Medicare |
$13,735.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,509.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,509.08
|
| Rate for Payer: BCBS MAPPO |
$13,207.26
|
| Rate for Payer: BCBS Trust/PPO |
$31,381.98
|
| Rate for Payer: BCN Commercial |
$31,381.98
|
| Rate for Payer: BCN Medicare Advantage |
$13,207.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,207.26
|
| Rate for Payer: Mclaren Medicare |
$13,207.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,867.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,188.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,527.99
|
| Rate for Payer: Nomi Health Commercial |
$19,458.36
|
| Rate for Payer: PACE Medicare |
$12,546.90
|
| Rate for Payer: PACE SWMI |
$13,207.26
|
| Rate for Payer: PHP Medicare Advantage |
$13,207.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,318.64
|
| Rate for Payer: Priority Health Medicare |
$13,207.26
|
| Rate for Payer: Priority Health Tiered Network |
$19,454.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13,207.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,586.92
|
| Rate for Payer: UHC Core |
$20,570.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,207.26
|
| Rate for Payer: UHC Exchange |
$16,799.05
|
| Rate for Payer: VA VA |
$13,207.26
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$45,151.40
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$19,128.96 |
| Max. Negotiated Rate |
$45,151.40 |
| Rate for Payer: Aetna Medicare |
$20,941.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,169.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,169.69
|
| Rate for Payer: BCBS MAPPO |
$20,135.75
|
| Rate for Payer: BCBS Trust/PPO |
$45,151.40
|
| Rate for Payer: BCN Commercial |
$45,151.40
|
| Rate for Payer: BCN Medicare Advantage |
$20,135.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,135.75
|
| Rate for Payer: Mclaren Medicare |
$20,135.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,142.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,156.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,149.33
|
| Rate for Payer: Nomi Health Commercial |
$30,146.01
|
| Rate for Payer: PACE Medicare |
$19,128.96
|
| Rate for Payer: PACE SWMI |
$20,135.75
|
| Rate for Payer: PHP Medicare Advantage |
$20,135.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,675.83
|
| Rate for Payer: Priority Health Medicare |
$20,135.75
|
| Rate for Payer: Priority Health Tiered Network |
$30,140.66
|
| Rate for Payer: Railroad Medicare Medicare |
$20,135.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,091.47
|
| Rate for Payer: UHC Core |
$31,868.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,135.75
|
| Rate for Payer: UHC Exchange |
$26,026.06
|
| Rate for Payer: VA VA |
$20,135.75
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$67,005.15
|
|
|
Service Code
|
MSDRG 939
|
| Min. Negotiated Rate |
$29,390.14 |
| Max. Negotiated Rate |
$67,005.15 |
| Rate for Payer: Aetna Medicare |
$32,174.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,671.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,671.24
|
| Rate for Payer: BCBS MAPPO |
$30,936.99
|
| Rate for Payer: BCBS Trust/PPO |
$67,005.15
|
| Rate for Payer: BCN Commercial |
$67,005.15
|
| Rate for Payer: BCN Medicare Advantage |
$30,936.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,936.99
|
| Rate for Payer: Mclaren Medicare |
$30,936.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,483.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,577.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,030.69
|
| Rate for Payer: Nomi Health Commercial |
$46,807.65
|
| Rate for Payer: PACE Medicare |
$29,390.14
|
| Rate for Payer: PACE SWMI |
$30,936.99
|
| Rate for Payer: PHP Medicare Advantage |
$30,936.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58,499.18
|
| Rate for Payer: Priority Health Medicare |
$30,936.99
|
| Rate for Payer: Priority Health Tiered Network |
$46,799.34
|
| Rate for Payer: Railroad Medicare Medicare |
$30,936.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,144.55
|
| Rate for Payer: UHC Core |
$49,481.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,936.99
|
| Rate for Payer: UHC Exchange |
$40,410.60
|
| Rate for Payer: VA VA |
$30,936.99
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,865.91
|
|
|
Service Code
|
MSDRG 941
|
| Min. Negotiated Rate |
$16,672.51 |
| Max. Negotiated Rate |
$37,865.91 |
| Rate for Payer: Aetna Medicare |
$18,252.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,937.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,937.51
|
| Rate for Payer: BCBS MAPPO |
$17,550.01
|
| Rate for Payer: BCBS Trust/PPO |
$37,865.91
|
| Rate for Payer: BCN Commercial |
$37,865.91
|
| Rate for Payer: BCN Medicare Advantage |
$17,550.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,550.01
|
| Rate for Payer: Mclaren Medicare |
$17,550.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,427.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,182.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,305.01
|
| Rate for Payer: Nomi Health Commercial |
$26,157.33
|
| Rate for Payer: PACE Medicare |
$16,672.51
|
| Rate for Payer: PACE SWMI |
$17,550.01
|
| Rate for Payer: PHP Medicare Advantage |
$17,550.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$32,690.86
|
| Rate for Payer: Priority Health Medicare |
$17,550.01
|
| Rate for Payer: Priority Health Tiered Network |
$26,152.69
|
| Rate for Payer: Railroad Medicare Medicare |
$17,550.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,051.51
|
| Rate for Payer: UHC Core |
$27,651.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,550.01
|
| Rate for Payer: UHC Exchange |
$22,582.49
|
| Rate for Payer: VA VA |
$17,550.01
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$62,997.87
|
|
|
Service Code
|
MSDRG 876
|
| Min. Negotiated Rate |
$31,268.25 |
| Max. Negotiated Rate |
$62,997.87 |
| Rate for Payer: Aetna Medicare |
$34,230.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,142.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,142.44
|
| Rate for Payer: BCBS MAPPO |
$32,913.95
|
| Rate for Payer: BCBS Trust/PPO |
$54,531.41
|
| Rate for Payer: BCN Commercial |
$54,531.41
|
| Rate for Payer: BCN Medicare Advantage |
$32,913.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,913.95
|
| Rate for Payer: Mclaren Medicare |
$32,913.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,559.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,851.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,205.35
|
| Rate for Payer: Nomi Health Commercial |
$49,857.21
|
| Rate for Payer: PACE Medicare |
$31,268.25
|
| Rate for Payer: PACE SWMI |
$32,913.95
|
| Rate for Payer: PHP Medicare Advantage |
$32,913.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,310.46
|
| Rate for Payer: Priority Health Medicare |
$32,913.95
|
| Rate for Payer: Priority Health Tiered Network |
$49,848.36
|
| Rate for Payer: Railroad Medicare Medicare |
$32,913.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62,997.87
|
| Rate for Payer: UHC Core |
$52,705.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,913.95
|
| Rate for Payer: UHC Exchange |
$43,043.39
|
| Rate for Payer: VA VA |
$32,913.95
|
|
|
ORTHODONTIC WAX
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 09900000566
|
| Hospital Charge Code |
168918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Advantage |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
ORTHODONTIC WAX
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 09900000566
|
| Hospital Charge Code |
168918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna American Axle |
$1.30
|
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.30
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Advantage |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.60
|
| Rate for Payer: Healthscope Commercial |
$1.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: PHP Commercial |
$1.70
|
| Rate for Payer: Priority Health SBD |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.30
|
| Rate for Payer: UHC Core |
$1.04
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.50
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$479.49
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.41 |
| Max. Negotiated Rate |
$431.54 |
| Rate for Payer: Aetna American Axle |
$311.67
|
| Rate for Payer: Aetna Commercial |
$407.57
|
| Rate for Payer: Aetna Medicare |
$239.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.67
|
| Rate for Payer: BCBS Complete |
$191.80
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Advantage |
$335.64
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$335.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$359.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.62
|
| Rate for Payer: PHP Commercial |
$407.57
|
| Rate for Payer: Priority Health SBD |
$302.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.67
|
| Rate for Payer: UHC Core |
$249.81
|
| Rate for Payer: UHC Exchange |
$188.44
|
| Rate for Payer: UMR Bronson Commercial |
$177.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$359.62
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$273.73
|
|
|
Service Code
|
NDC 60219126401
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$246.36 |
| Rate for Payer: Aetna American Axle |
$177.92
|
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.92
|
| Rate for Payer: Cash Price |
$218.98
|
| Rate for Payer: Cofinity Advantage |
$191.61
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$246.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.30
|
| Rate for Payer: PHP Commercial |
$232.67
|
| Rate for Payer: Priority Health SBD |
$172.45
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.30
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna American Axle |
$41.41
|
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.41
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Advantage |
$44.59
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$44.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.77
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: Priority Health SBD |
$40.13
|
| Rate for Payer: UMR Bronson Commercial |
$28.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.70 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Advantage |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UMR Bronson Commercial |
$141.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna American Axle |
$41.41
|
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.41
|
| Rate for Payer: BCBS Complete |
$25.48
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Advantage |
$44.59
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$44.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.77
|
| Rate for Payer: PHP Commercial |
$54.15
|
| Rate for Payer: Priority Health SBD |
$40.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.41
|
| Rate for Payer: UHC Core |
$33.19
|
| Rate for Payer: UHC Exchange |
$25.03
|
| Rate for Payer: UMR Bronson Commercial |
$23.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.77
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$273.73
|
|
|
Service Code
|
NDC 60219126401
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$246.36 |
| Rate for Payer: Aetna American Axle |
$177.92
|
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare |
$136.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.92
|
| Rate for Payer: BCBS Complete |
$109.49
|
| Rate for Payer: Cash Price |
$218.98
|
| Rate for Payer: Cofinity Advantage |
$191.61
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$246.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.30
|
| Rate for Payer: PHP Commercial |
$232.67
|
| Rate for Payer: Priority Health SBD |
$172.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.92
|
| Rate for Payer: UHC Core |
$142.61
|
| Rate for Payer: UHC Exchange |
$107.58
|
| Rate for Payer: UMR Bronson Commercial |
$101.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.30
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$273.73
|
|
|
Service Code
|
NDC 69238126401
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$246.36 |
| Rate for Payer: Aetna American Axle |
$177.92
|
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna Medicare |
$136.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.92
|
| Rate for Payer: BCBS Complete |
$109.49
|
| Rate for Payer: Cash Price |
$218.98
|
| Rate for Payer: Cofinity Advantage |
$191.61
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$246.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.30
|
| Rate for Payer: PHP Commercial |
$232.67
|
| Rate for Payer: Priority Health SBD |
$172.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.92
|
| Rate for Payer: UHC Core |
$142.61
|
| Rate for Payer: UHC Exchange |
$107.58
|
| Rate for Payer: UMR Bronson Commercial |
$101.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.30
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$79.30
|
|
|
Service Code
|
NDC 70710100802
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.34 |
| Max. Negotiated Rate |
$71.37 |
| Rate for Payer: Aetna American Axle |
$51.55
|
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Aetna Medicare |
$39.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.55
|
| Rate for Payer: BCBS Complete |
$31.72
|
| Rate for Payer: Cash Price |
$63.44
|
| Rate for Payer: Cofinity Advantage |
$55.51
|
| Rate for Payer: Cofinity Commercial |
$68.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.44
|
| Rate for Payer: Healthscope Commercial |
$71.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.48
|
| Rate for Payer: PHP Commercial |
$67.41
|
| Rate for Payer: Priority Health SBD |
$49.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.55
|
| Rate for Payer: UHC Core |
$41.32
|
| Rate for Payer: UHC Exchange |
$31.16
|
| Rate for Payer: UMR Bronson Commercial |
$29.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.48
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$79.30
|
|
|
Service Code
|
NDC 70710100802
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.89 |
| Max. Negotiated Rate |
$71.37 |
| Rate for Payer: Aetna American Axle |
$51.55
|
| Rate for Payer: Aetna Commercial |
$67.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.55
|
| Rate for Payer: Cash Price |
$63.44
|
| Rate for Payer: Cofinity Advantage |
$55.51
|
| Rate for Payer: Cofinity Commercial |
$68.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.44
|
| Rate for Payer: Healthscope Commercial |
$71.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.48
|
| Rate for Payer: PHP Commercial |
$67.41
|
| Rate for Payer: Priority Health SBD |
$49.96
|
| Rate for Payer: UMR Bronson Commercial |
$34.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.48
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$273.73
|
|
|
Service Code
|
NDC 69238126401
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$246.36 |
| Rate for Payer: Aetna American Axle |
$177.92
|
| Rate for Payer: Aetna Commercial |
$232.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.92
|
| Rate for Payer: Cash Price |
$218.98
|
| Rate for Payer: Cofinity Advantage |
$191.61
|
| Rate for Payer: Cofinity Commercial |
$235.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.98
|
| Rate for Payer: Healthscope Commercial |
$246.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.30
|
| Rate for Payer: PHP Commercial |
$232.67
|
| Rate for Payer: Priority Health SBD |
$172.45
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.30
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$289.85 |
| Rate for Payer: Aetna American Axle |
$209.33
|
| Rate for Payer: Aetna Commercial |
$273.74
|
| Rate for Payer: Aetna Medicare |
$161.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.33
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Advantage |
$225.44
|
| Rate for Payer: Cofinity Commercial |
$276.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$289.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: PHP Commercial |
$273.74
|
| Rate for Payer: Priority Health SBD |
$202.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.33
|
| Rate for Payer: UHC Core |
$167.79
|
| Rate for Payer: UHC Exchange |
$126.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.54
|
|
