|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$44.05
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.84 |
| Max. Negotiated Rate |
$44.05 |
| Rate for Payer: Aetna Commercial |
$39.64
|
| Rate for Payer: Aetna Commercial |
$44.69
|
| Rate for Payer: Aetna Commercial |
$55.11
|
| Rate for Payer: ASR ASR |
$59.39
|
| Rate for Payer: ASR ASR |
$48.17
|
| Rate for Payer: ASR ASR |
$42.73
|
| Rate for Payer: BCBS Trust/PPO |
$34.15
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.47
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: BCN Commercial |
$47.47
|
| Rate for Payer: BCN Commercial |
$34.15
|
| Rate for Payer: Cash Price |
$39.73
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$57.56
|
| Rate for Payer: Cofinity Commercial |
$46.68
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.73
|
| Rate for Payer: Healthscope Commercial |
$44.05
|
| Rate for Payer: Healthscope Commercial |
$61.23
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Whirlpool |
$48.17
|
| Rate for Payer: Healthscope Whirlpool |
$59.39
|
| Rate for Payer: Healthscope Whirlpool |
$42.73
|
| Rate for Payer: Mclaren Commercial |
$44.69
|
| Rate for Payer: Mclaren Commercial |
$39.64
|
| Rate for Payer: Mclaren Commercial |
$55.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.76
|
|
|
ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 43386-480-24
|
| Hospital Charge Code |
27146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.86 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$245.38
|
| Rate for Payer: ASR ASR |
$264.47
|
| Rate for Payer: BCBS Trust/PPO |
$211.39
|
| Rate for Payer: BCN Commercial |
$211.39
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$256.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$272.65
|
| Rate for Payer: Healthscope Whirlpool |
$264.47
|
| Rate for Payer: Mclaren Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.93
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$20,829.05
|
|
|
Service Code
|
MS-DRG 620
|
| Min. Negotiated Rate |
$14,644.37 |
| Max. Negotiated Rate |
$20,829.05 |
| Rate for Payer: Aetna Medicare |
$15,415.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,268.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,268.91
|
| Rate for Payer: BCBS MAPPO |
$15,415.13
|
| Rate for Payer: BCN Medicare Advantage |
$15,415.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,415.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,415.13
|
| Rate for Payer: Mclaren Medicare |
$15,415.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,185.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,727.40
|
| Rate for Payer: PACE Medicare |
$14,644.37
|
| Rate for Payer: PACE SWMI |
$15,415.13
|
| Rate for Payer: PHP Commercial |
$16,956.64
|
| Rate for Payer: PHP Medicare Advantage |
$15,415.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,829.05
|
| Rate for Payer: Priority Health Medicare |
$15,415.13
|
| Rate for Payer: Priority Health Narrow Network |
$16,663.24
|
| Rate for Payer: Railroad Medicare Medicare |
$15,415.13
|
| Rate for Payer: UHC Medicare Advantage |
$15,877.58
|
| Rate for Payer: VA VA |
$15,415.13
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$33,236.34
|
|
|
Service Code
|
MS-DRG 619
|
| Min. Negotiated Rate |
$22,529.01 |
| Max. Negotiated Rate |
$33,236.34 |
| Rate for Payer: Aetna Medicare |
$23,714.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,643.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,643.44
|
| Rate for Payer: BCBS MAPPO |
$23,714.75
|
| Rate for Payer: BCN Medicare Advantage |
$23,714.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,714.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,714.75
|
| Rate for Payer: Mclaren Medicare |
$23,714.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,900.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,271.96
|
| Rate for Payer: PACE Medicare |
$22,529.01
|
| Rate for Payer: PACE SWMI |
$23,714.75
|
| Rate for Payer: PHP Commercial |
$26,086.22
|
| Rate for Payer: PHP Medicare Advantage |
$23,714.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,236.34
|
| Rate for Payer: Priority Health Medicare |
$23,714.75
|
| Rate for Payer: Priority Health Narrow Network |
$26,589.07
|
| Rate for Payer: Railroad Medicare Medicare |
$23,714.75
|
| Rate for Payer: UHC Medicare Advantage |
$24,426.19
|
| Rate for Payer: VA VA |
$23,714.75
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$19,482.13
|
|
|
Service Code
|
MS-DRG 621
|
| Min. Negotiated Rate |
$13,800.66 |
| Max. Negotiated Rate |
$19,482.13 |
| Rate for Payer: Aetna Medicare |
$14,527.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,158.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,158.76
|
| Rate for Payer: BCBS MAPPO |
$14,527.01
|
| Rate for Payer: BCN Medicare Advantage |
$14,527.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,527.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,527.01
|
| Rate for Payer: Mclaren Medicare |
$14,527.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,253.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,706.06
|
| Rate for Payer: PACE Medicare |
$13,800.66
|
| Rate for Payer: PACE SWMI |
$14,527.01
|
| Rate for Payer: PHP Commercial |
$15,979.71
|
| Rate for Payer: PHP Medicare Advantage |
$14,527.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,482.13
|
| Rate for Payer: Priority Health Medicare |
$14,527.01
|
| Rate for Payer: Priority Health Narrow Network |
$15,585.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14,527.01
|
| Rate for Payer: UHC Medicare Advantage |
$14,962.82
|
| Rate for Payer: VA VA |
$14,527.01
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$27,819.14
|
|
|
Service Code
|
MS-DRG 940
|
| Min. Negotiated Rate |
$19,023.03 |
| Max. Negotiated Rate |
$27,819.14 |
| Rate for Payer: Aetna Medicare |
$20,024.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,030.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,030.30
|
| Rate for Payer: BCBS MAPPO |
$20,024.24
|
| Rate for Payer: BCN Medicare Advantage |
$20,024.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,024.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,024.24
|
| Rate for Payer: Mclaren Medicare |
$20,024.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,025.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,027.88
|
| Rate for Payer: PACE Medicare |
$19,023.03
|
| Rate for Payer: PACE SWMI |
$20,024.24
|
| Rate for Payer: PHP Commercial |
$22,026.66
|
| Rate for Payer: PHP Medicare Advantage |
$20,024.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,819.14
|
| Rate for Payer: Priority Health Medicare |
$20,024.24
|
| Rate for Payer: Priority Health Narrow Network |
$22,255.31
|
| Rate for Payer: Railroad Medicare Medicare |
$20,024.24
|
| Rate for Payer: UHC Medicare Advantage |
$20,624.97
|
| Rate for Payer: VA VA |
$20,024.24
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$41,284.45
|
|
|
Service Code
|
MS-DRG 939
|
| Min. Negotiated Rate |
$27,457.79 |
| Max. Negotiated Rate |
$41,284.45 |
| Rate for Payer: Aetna Medicare |
$28,902.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,128.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,128.68
|
| Rate for Payer: BCBS MAPPO |
$28,902.94
|
| Rate for Payer: BCN Medicare Advantage |
$28,902.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,902.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,902.94
|
| Rate for Payer: Mclaren Medicare |
$28,902.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,348.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,238.38
|
| Rate for Payer: PACE Medicare |
$27,457.79
|
| Rate for Payer: PACE SWMI |
$28,902.94
|
| Rate for Payer: PHP Commercial |
$31,793.23
|
| Rate for Payer: PHP Medicare Advantage |
$28,902.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,284.45
|
| Rate for Payer: Priority Health Medicare |
$28,902.94
|
| Rate for Payer: Priority Health Narrow Network |
$33,027.56
|
| Rate for Payer: Railroad Medicare Medicare |
$28,902.94
|
| Rate for Payer: UHC Medicare Advantage |
$29,770.03
|
| Rate for Payer: VA VA |
$28,902.94
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,831.04
|
|
|
Service Code
|
MS-DRG 941
|
| Min. Negotiated Rate |
$16,524.83 |
| Max. Negotiated Rate |
$23,831.04 |
| Rate for Payer: Aetna Medicare |
$17,394.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,743.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,743.20
|
| Rate for Payer: BCBS MAPPO |
$17,394.56
|
| Rate for Payer: BCN Medicare Advantage |
$17,394.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,394.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,394.56
|
| Rate for Payer: Mclaren Medicare |
$17,394.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,264.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,003.74
|
| Rate for Payer: PACE Medicare |
$16,524.83
|
| Rate for Payer: PACE SWMI |
$17,394.56
|
| Rate for Payer: PHP Commercial |
$19,134.02
|
| Rate for Payer: PHP Medicare Advantage |
$17,394.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,831.04
|
| Rate for Payer: Priority Health Medicare |
$17,394.56
|
| Rate for Payer: Priority Health Narrow Network |
$19,064.83
|
| Rate for Payer: Railroad Medicare Medicare |
$17,394.56
|
| Rate for Payer: UHC Medicare Advantage |
$17,916.40
|
| Rate for Payer: VA VA |
$17,394.56
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$47,912.46
|
|
|
Service Code
|
MS-DRG 876
|
| Min. Negotiated Rate |
$31,609.64 |
| Max. Negotiated Rate |
$47,912.46 |
| Rate for Payer: Aetna Medicare |
$33,273.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,591.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,591.62
|
| Rate for Payer: BCBS MAPPO |
$33,273.30
|
| Rate for Payer: BCN Medicare Advantage |
$33,273.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,273.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$33,273.30
|
| Rate for Payer: Mclaren Medicare |
$33,273.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,936.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,264.30
|
| Rate for Payer: PACE Medicare |
$31,609.64
|
| Rate for Payer: PACE SWMI |
$33,273.30
|
| Rate for Payer: PHP Commercial |
$36,600.63
|
| Rate for Payer: PHP Medicare Advantage |
$33,273.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47,912.46
|
| Rate for Payer: Priority Health Medicare |
$33,273.30
|
| Rate for Payer: Priority Health Narrow Network |
$38,329.97
|
| Rate for Payer: Railroad Medicare Medicare |
$33,273.30
|
| Rate for Payer: UHC Medicare Advantage |
$34,271.50
|
| Rate for Payer: VA VA |
$33,273.30
|
|
|
ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS J7324
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$169.02 |
| Rate for Payer: Aetna Commercial |
$157.29
|
| Rate for Payer: Aetna Medicare |
$117.38
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$117.38
|
| Rate for Payer: BCBS Trust/PPO |
$133.10
|
| Rate for Payer: BCN Commercial |
$130.97
|
| Rate for Payer: BCN Medicare Advantage |
$117.38
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$169.02
|
| Rate for Payer: Cofinity Commercial |
$157.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.38
|
| Rate for Payer: Healthscope Commercial |
$140.85
|
| Rate for Payer: Healthscope Whirlpool |
$140.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.25
|
| Rate for Payer: PACE SWMI |
$117.38
|
| Rate for Payer: PHP Medicare Advantage |
$117.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.50
|
| Rate for Payer: Priority Health Medicare |
$117.38
|
| Rate for Payer: UHC Medicare Advantage |
$120.90
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$38.74
|
|
|
Service Code
|
NDC 68180-675-11
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$34.87
|
| Rate for Payer: ASR ASR |
$37.58
|
| Rate for Payer: BCBS Trust/PPO |
$30.04
|
| Rate for Payer: BCN Commercial |
$30.04
|
| Rate for Payer: Cash Price |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.99
|
| Rate for Payer: Healthscope Commercial |
$38.74
|
| Rate for Payer: Healthscope Whirlpool |
$37.58
|
| Rate for Payer: Mclaren Commercial |
$34.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.09
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.48
|
|
|
Service Code
|
NDC 0004-0802-85
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.64 |
| Max. Negotiated Rate |
$479.48 |
| Rate for Payer: Aetna Commercial |
$431.53
|
| Rate for Payer: ASR ASR |
$465.10
|
| Rate for Payer: BCBS Trust/PPO |
$371.74
|
| Rate for Payer: BCN Commercial |
$371.74
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$450.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.58
|
| Rate for Payer: Healthscope Commercial |
$479.48
|
| Rate for Payer: Healthscope Whirlpool |
$465.10
|
| Rate for Payer: Mclaren Commercial |
$431.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.94
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 47781-468-13
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.44 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$289.84
|
| Rate for Payer: ASR ASR |
$312.39
|
| Rate for Payer: BCBS Trust/PPO |
$249.69
|
| Rate for Payer: BCN Commercial |
$249.69
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$302.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$322.05
|
| Rate for Payer: Healthscope Whirlpool |
$312.39
|
| Rate for Payer: Mclaren Commercial |
$289.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$273.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.40
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$522.59
|
|
|
Service Code
|
NDC 0004-0822-05
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.81 |
| Max. Negotiated Rate |
$522.59 |
| Rate for Payer: Aetna Commercial |
$470.33
|
| Rate for Payer: ASR ASR |
$506.91
|
| Rate for Payer: BCBS Trust/PPO |
$405.16
|
| Rate for Payer: BCN Commercial |
$405.16
|
| Rate for Payer: Cash Price |
$418.07
|
| Rate for Payer: Cofinity Commercial |
$491.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.07
|
| Rate for Payer: Healthscope Commercial |
$522.59
|
| Rate for Payer: Healthscope Whirlpool |
$506.91
|
| Rate for Payer: Mclaren Commercial |
$470.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.88
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 68180-678-01
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: ASR ASR |
$221.16
|
| Rate for Payer: BCBS Trust/PPO |
$176.77
|
| Rate for Payer: BCN Commercial |
$176.77
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$214.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$228.00
|
| Rate for Payer: Healthscope Whirlpool |
$221.16
|
| Rate for Payer: Mclaren Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.64
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$447.55
|
|
|
Service Code
|
NDC 47781-384-26
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.28 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: ASR ASR |
$434.12
|
| Rate for Payer: BCBS Trust/PPO |
$346.99
|
| Rate for Payer: BCN Commercial |
$346.99
|
| Rate for Payer: Cash Price |
$358.04
|
| Rate for Payer: Cofinity Commercial |
$420.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.04
|
| Rate for Payer: Healthscope Commercial |
$447.55
|
| Rate for Payer: Healthscope Whirlpool |
$434.12
|
| Rate for Payer: Mclaren Commercial |
$402.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.84
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$275.24
|
|
|
Service Code
|
NDC 62332-415-10
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.67 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: ASR ASR |
$266.98
|
| Rate for Payer: BCBS Trust/PPO |
$213.39
|
| Rate for Payer: BCN Commercial |
$213.39
|
| Rate for Payer: Cash Price |
$220.19
|
| Rate for Payer: Cofinity Commercial |
$258.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.19
|
| Rate for Payer: Healthscope Commercial |
$275.24
|
| Rate for Payer: Healthscope Whirlpool |
$266.98
|
| Rate for Payer: Mclaren Commercial |
$247.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$233.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.21
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.62
|
|
|
Service Code
|
NDC 0004-0800-85
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$365.83 |
| Max. Negotiated Rate |
$522.62 |
| Rate for Payer: Aetna Commercial |
$470.36
|
| Rate for Payer: ASR ASR |
$506.94
|
| Rate for Payer: BCBS Trust/PPO |
$405.19
|
| Rate for Payer: BCN Commercial |
$405.19
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$491.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$522.62
|
| Rate for Payer: Healthscope Whirlpool |
$506.94
|
| Rate for Payer: Mclaren Commercial |
$470.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.91
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$52.42
|
|
|
Service Code
|
NDC 68180-677-11
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: ASR ASR |
$50.85
|
| Rate for Payer: BCBS Trust/PPO |
$40.64
|
| Rate for Payer: BCN Commercial |
$40.64
|
| Rate for Payer: Cash Price |
$41.93
|
| Rate for Payer: Cofinity Commercial |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.94
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Whirlpool |
$50.85
|
| Rate for Payer: Mclaren Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.13
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$276.20
|
|
|
Service Code
|
NDC 70710-1010-2
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.34 |
| Max. Negotiated Rate |
$276.20 |
| Rate for Payer: Aetna Commercial |
$248.58
|
| Rate for Payer: ASR ASR |
$267.91
|
| Rate for Payer: BCBS Trust/PPO |
$214.14
|
| Rate for Payer: BCN Commercial |
$214.14
|
| Rate for Payer: Cash Price |
$220.96
|
| Rate for Payer: Cofinity Commercial |
$259.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.96
|
| Rate for Payer: Healthscope Commercial |
$276.20
|
| Rate for Payer: Healthscope Whirlpool |
$267.91
|
| Rate for Payer: Mclaren Commercial |
$248.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.06
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$351.02
|
|
|
Service Code
|
NDC 47781-470-13
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.71 |
| Max. Negotiated Rate |
$351.02 |
| Rate for Payer: Aetna Commercial |
$315.92
|
| Rate for Payer: ASR ASR |
$340.49
|
| Rate for Payer: BCBS Trust/PPO |
$272.15
|
| Rate for Payer: BCN Commercial |
$272.15
|
| Rate for Payer: Cash Price |
$280.82
|
| Rate for Payer: Cofinity Commercial |
$329.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.82
|
| Rate for Payer: Healthscope Commercial |
$351.02
|
| Rate for Payer: Healthscope Whirlpool |
$340.49
|
| Rate for Payer: Mclaren Commercial |
$315.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.90
|
|
|
OSTEOMYELITIS WITH CC
|
Facility
|
IP
|
$16,668.89
|
|
|
Service Code
|
MS-DRG 540
|
| Min. Negotiated Rate |
$12,038.43 |
| Max. Negotiated Rate |
$16,668.89 |
| Rate for Payer: Aetna Medicare |
$12,672.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,840.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,840.04
|
| Rate for Payer: BCBS MAPPO |
$12,672.03
|
| Rate for Payer: BCN Medicare Advantage |
$12,672.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,672.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,672.03
|
| Rate for Payer: Mclaren Medicare |
$12,672.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,305.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,572.83
|
| Rate for Payer: PACE Medicare |
$12,038.43
|
| Rate for Payer: PACE SWMI |
$12,672.03
|
| Rate for Payer: PHP Commercial |
$13,939.23
|
| Rate for Payer: PHP Medicare Advantage |
$12,672.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,668.89
|
| Rate for Payer: Priority Health Medicare |
$12,672.03
|
| Rate for Payer: Priority Health Narrow Network |
$13,335.11
|
| Rate for Payer: Railroad Medicare Medicare |
$12,672.03
|
| Rate for Payer: UHC Medicare Advantage |
$13,052.19
|
| Rate for Payer: VA VA |
$12,672.03
|
|
|
OSTEOMYELITIS WITH MCC
|
Facility
|
IP
|
$25,479.70
|
|
|
Service Code
|
MS-DRG 539
|
| Min. Negotiated Rate |
$17,557.57 |
| Max. Negotiated Rate |
$25,479.70 |
| Rate for Payer: Aetna Medicare |
$18,481.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,102.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,102.06
|
| Rate for Payer: BCBS MAPPO |
$18,481.65
|
| Rate for Payer: BCN Medicare Advantage |
$18,481.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,481.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,481.65
|
| Rate for Payer: Mclaren Medicare |
$18,481.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,405.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,253.90
|
| Rate for Payer: PACE Medicare |
$17,557.57
|
| Rate for Payer: PACE SWMI |
$18,481.65
|
| Rate for Payer: PHP Commercial |
$20,329.82
|
| Rate for Payer: PHP Medicare Advantage |
$18,481.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,479.70
|
| Rate for Payer: Priority Health Medicare |
$18,481.65
|
| Rate for Payer: Priority Health Narrow Network |
$20,383.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,481.65
|
| Rate for Payer: UHC Medicare Advantage |
$19,036.10
|
| Rate for Payer: VA VA |
$18,481.65
|
|
|
OSTEOMYELITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,180.32
|
|
|
Service Code
|
MS-DRG 541
|
| Min. Negotiated Rate |
$8,497.05 |
| Max. Negotiated Rate |
$11,180.32 |
| Rate for Payer: Aetna Medicare |
$8,944.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,180.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,180.32
|
| Rate for Payer: BCBS MAPPO |
$8,944.26
|
| Rate for Payer: BCN Medicare Advantage |
$8,944.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,944.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,944.26
|
| Rate for Payer: Mclaren Medicare |
$8,944.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,391.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,285.90
|
| Rate for Payer: PACE Medicare |
$8,497.05
|
| Rate for Payer: PACE SWMI |
$8,944.26
|
| Rate for Payer: PHP Commercial |
$9,838.69
|
| Rate for Payer: PHP Medicare Advantage |
$8,944.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,015.44
|
| Rate for Payer: Priority Health Medicare |
$8,944.26
|
| Rate for Payer: Priority Health Narrow Network |
$8,812.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8,944.26
|
| Rate for Payer: UHC Medicare Advantage |
$9,212.59
|
| Rate for Payer: VA VA |
$8,944.26
|
|
|
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$17,246.50
|
|
|
Service Code
|
MS-DRG 818
|
| Min. Negotiated Rate |
$12,050.08 |
| Max. Negotiated Rate |
$17,246.50 |
| Rate for Payer: Aetna Medicare |
$13,797.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,246.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,246.50
|
| Rate for Payer: BCBS MAPPO |
$13,797.20
|
| Rate for Payer: BCN Medicare Advantage |
$13,797.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,797.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,797.20
|
| Rate for Payer: Mclaren Medicare |
$13,797.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,487.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,866.78
|
| Rate for Payer: PACE Medicare |
$13,107.34
|
| Rate for Payer: PACE SWMI |
$13,797.20
|
| Rate for Payer: PHP Commercial |
$15,176.92
|
| Rate for Payer: PHP Medicare Advantage |
$13,797.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,062.60
|
| Rate for Payer: Priority Health Medicare |
$13,797.20
|
| Rate for Payer: Priority Health Narrow Network |
$12,050.08
|
| Rate for Payer: Railroad Medicare Medicare |
$13,797.20
|
| Rate for Payer: UHC Medicare Advantage |
$14,211.12
|
| Rate for Payer: VA VA |
$13,797.20
|
|
