|
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 |
$63.70 |
| Rate for Payer: Aetna Commercial |
$57.33
|
| Rate for Payer: Aetna Medicare |
$23.57
|
| Rate for Payer: ASR ASR |
$61.79
|
| Rate for Payer: BCBS Complete |
$25.48
|
| Rate for Payer: BCBS Trust/PPO |
$52.52
|
| Rate for Payer: BCN Commercial |
$52.52
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$59.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$61.79
|
| Rate for Payer: Healthscope Whirlpool |
$63.70
|
| Rate for Payer: Mclaren Commercial |
$57.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.14
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.81
|
| Rate for Payer: Priority Health Narrow Network |
$44.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.05
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$522.59
|
|
|
Service Code
|
NDC 4082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.94 |
| 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 |
$429.15
|
| Rate for Payer: BCN Commercial |
$429.15
|
| 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 |
$506.91
|
| Rate for Payer: Healthscope Whirlpool |
$522.59
|
| Rate for Payer: Mclaren Commercial |
$470.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.88
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$447.55
|
|
|
Service Code
|
NDC 47781038426
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.66 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: ASR ASR |
$434.13
|
| Rate for Payer: BCBS Trust/PPO |
$367.53
|
| Rate for Payer: BCN Commercial |
$367.53
|
| 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 |
$434.13
|
| Rate for Payer: Healthscope Whirlpool |
$447.55
|
| Rate for Payer: Mclaren Commercial |
$402.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.42
|
| Rate for Payer: Nomi Health Commercial |
$366.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.85
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$218.55
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.86 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna Commercial |
$196.69
|
| Rate for Payer: Aetna Medicare |
$80.86
|
| Rate for Payer: ASR ASR |
$211.99
|
| Rate for Payer: BCBS Complete |
$87.42
|
| Rate for Payer: BCBS Trust/PPO |
$180.19
|
| Rate for Payer: BCN Commercial |
$180.19
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$205.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$211.99
|
| Rate for Payer: Healthscope Whirlpool |
$218.55
|
| Rate for Payer: Mclaren Commercial |
$196.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$191.49
|
| Rate for Payer: Priority Health Narrow Network |
$153.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.32
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$447.55
|
|
|
Service Code
|
NDC 47781038426
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.59 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: Aetna Medicare |
$165.59
|
| Rate for Payer: ASR ASR |
$434.13
|
| Rate for Payer: BCBS Complete |
$179.02
|
| Rate for Payer: BCBS Trust/PPO |
$369.01
|
| Rate for Payer: BCN Commercial |
$369.01
|
| 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 |
$434.13
|
| Rate for Payer: Healthscope Whirlpool |
$447.55
|
| Rate for Payer: Mclaren Commercial |
$402.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.42
|
| Rate for Payer: Nomi Health Commercial |
$366.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$392.15
|
| Rate for Payer: Priority Health Narrow Network |
$313.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.85
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$522.59
|
|
|
Service Code
|
NDC 4082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$522.59 |
| Rate for Payer: Aetna Commercial |
$470.33
|
| Rate for Payer: Aetna Medicare |
$193.36
|
| Rate for Payer: ASR ASR |
$506.91
|
| Rate for Payer: BCBS Complete |
$209.04
|
| Rate for Payer: BCBS Trust/PPO |
$430.87
|
| Rate for Payer: BCN Commercial |
$430.87
|
| 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 |
$506.91
|
| Rate for Payer: Healthscope Whirlpool |
$522.59
|
| Rate for Payer: Mclaren Commercial |
$470.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$418.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$457.89
|
| Rate for Payer: Priority Health Narrow Network |
$366.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.88
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$218.55
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.91 |
| Max. Negotiated Rate |
$218.55 |
| Rate for Payer: Aetna Commercial |
$196.69
|
| Rate for Payer: ASR ASR |
$211.99
|
| Rate for Payer: BCBS Trust/PPO |
$179.47
|
| Rate for Payer: BCN Commercial |
$179.47
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cofinity Commercial |
$205.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.84
|
| Rate for Payer: Healthscope Commercial |
$211.99
|
| Rate for Payer: Healthscope Whirlpool |
$218.55
|
| Rate for Payer: Mclaren Commercial |
$196.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.77
|
| Rate for Payer: Nomi Health Commercial |
$179.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.32
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$82.61
|
|
|
Service Code
|
NDC 64380079901
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.96 |
| Max. Negotiated Rate |
$82.61 |
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: ASR ASR |
$80.13
|
| Rate for Payer: BCBS Trust/PPO |
$67.84
|
| Rate for Payer: BCN Commercial |
$67.84
|
| Rate for Payer: Cash Price |
$66.09
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.09
|
| Rate for Payer: Healthscope Commercial |
$80.13
|
| Rate for Payer: Healthscope Whirlpool |
$82.61
|
| Rate for Payer: Mclaren Commercial |
$74.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$67.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.70
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$63.60
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$57.24
|
| Rate for Payer: Aetna Medicare |
$23.53
|
| Rate for Payer: ASR ASR |
$61.69
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS Trust/PPO |
$52.44
|
| Rate for Payer: BCN Commercial |
$52.44
|
| Rate for Payer: Cash Price |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$59.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$61.69
|
| Rate for Payer: Healthscope Whirlpool |
$63.60
|
| Rate for Payer: Mclaren Commercial |
$57.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.06
|
| Rate for Payer: Nomi Health Commercial |
$52.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.73
|
| Rate for Payer: Priority Health Narrow Network |
$44.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$351.02
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.26 |
| 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 |
$288.26
|
| Rate for Payer: BCN Commercial |
$288.26
|
| 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 |
$340.49
|
| Rate for Payer: Healthscope Whirlpool |
$351.02
|
| Rate for Payer: Mclaren Commercial |
$315.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.37
|
| Rate for Payer: Nomi Health Commercial |
$287.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.90
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$85.73
|
|
|
Service Code
|
NDC 70710101002
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.30 |
| Max. Negotiated Rate |
$85.73 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: ASR ASR |
$83.16
|
| Rate for Payer: BCBS Trust/PPO |
$70.40
|
| Rate for Payer: BCN Commercial |
$70.40
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$80.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$83.16
|
| Rate for Payer: Healthscope Whirlpool |
$85.73
|
| Rate for Payer: Mclaren Commercial |
$77.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.87
|
| Rate for Payer: Nomi Health Commercial |
$70.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.44
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$82.61
|
|
|
Service Code
|
NDC 64380079901
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$82.61 |
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Medicare |
$30.56
|
| Rate for Payer: ASR ASR |
$80.13
|
| Rate for Payer: BCBS Complete |
$33.04
|
| Rate for Payer: BCBS Trust/PPO |
$68.11
|
| Rate for Payer: BCN Commercial |
$68.11
|
| Rate for Payer: Cash Price |
$66.09
|
| Rate for Payer: Cofinity Commercial |
$77.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.09
|
| Rate for Payer: Healthscope Commercial |
$80.13
|
| Rate for Payer: Healthscope Whirlpool |
$82.61
|
| Rate for Payer: Mclaren Commercial |
$74.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$67.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$72.38
|
| Rate for Payer: Priority Health Narrow Network |
$57.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.70
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$85.73
|
|
|
Service Code
|
NDC 70710101002
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$85.73 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: ASR ASR |
$83.16
|
| Rate for Payer: BCBS Complete |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$70.68
|
| Rate for Payer: BCN Commercial |
$70.68
|
| Rate for Payer: Cash Price |
$68.58
|
| Rate for Payer: Cofinity Commercial |
$80.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.58
|
| Rate for Payer: Healthscope Commercial |
$83.16
|
| Rate for Payer: Healthscope Whirlpool |
$85.73
|
| Rate for Payer: Mclaren Commercial |
$77.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.87
|
| Rate for Payer: Nomi Health Commercial |
$70.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.11
|
| Rate for Payer: Priority Health Narrow Network |
$60.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.44
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$275.24
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.43 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: ASR ASR |
$266.99
|
| Rate for Payer: BCBS Trust/PPO |
$226.03
|
| Rate for Payer: BCN Commercial |
$226.03
|
| 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 |
$266.99
|
| Rate for Payer: Healthscope Whirlpool |
$275.24
|
| Rate for Payer: Mclaren Commercial |
$247.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.96
|
| Rate for Payer: Nomi Health Commercial |
$225.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.21
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 4080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$391.97 |
| Max. Negotiated Rate |
$522.62 |
| Rate for Payer: Aetna Commercial |
$470.36
|
| Rate for Payer: ASR ASR |
$506.95
|
| Rate for Payer: BCBS Trust/PPO |
$429.18
|
| Rate for Payer: BCN Commercial |
$429.18
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$491.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$506.95
|
| Rate for Payer: Healthscope Whirlpool |
$522.62
|
| Rate for Payer: Mclaren Commercial |
$470.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.23
|
| Rate for Payer: Nomi Health Commercial |
$428.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.91
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$275.24
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.84 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: Aetna Medicare |
$101.84
|
| Rate for Payer: ASR ASR |
$266.99
|
| Rate for Payer: BCBS Complete |
$110.10
|
| Rate for Payer: BCBS Trust/PPO |
$226.94
|
| Rate for Payer: BCN Commercial |
$226.94
|
| 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 |
$266.99
|
| Rate for Payer: Healthscope Whirlpool |
$275.24
|
| Rate for Payer: Mclaren Commercial |
$247.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.96
|
| Rate for Payer: Nomi Health Commercial |
$225.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$241.17
|
| Rate for Payer: Priority Health Narrow Network |
$192.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.21
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.63
|
|
|
Service Code
|
NDC 4080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.37 |
| Max. Negotiated Rate |
$522.62 |
| Rate for Payer: Aetna Commercial |
$470.36
|
| Rate for Payer: Aetna Medicare |
$193.37
|
| Rate for Payer: ASR ASR |
$506.95
|
| Rate for Payer: BCBS Complete |
$209.05
|
| Rate for Payer: BCBS Trust/PPO |
$430.90
|
| Rate for Payer: BCN Commercial |
$430.90
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$491.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$506.95
|
| Rate for Payer: Healthscope Whirlpool |
$522.62
|
| Rate for Payer: Mclaren Commercial |
$470.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$418.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.23
|
| Rate for Payer: Nomi Health Commercial |
$428.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$391.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$457.92
|
| Rate for Payer: Priority Health Narrow Network |
$366.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.91
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$63.60
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.70 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$57.24
|
| Rate for Payer: ASR ASR |
$61.69
|
| Rate for Payer: BCBS Trust/PPO |
$52.23
|
| Rate for Payer: BCN Commercial |
$52.23
|
| Rate for Payer: Cash Price |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$59.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$61.69
|
| Rate for Payer: Healthscope Whirlpool |
$63.60
|
| Rate for Payer: Mclaren Commercial |
$57.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.06
|
| Rate for Payer: Nomi Health Commercial |
$52.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$351.02
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.88 |
| Max. Negotiated Rate |
$351.02 |
| Rate for Payer: Aetna Commercial |
$315.92
|
| Rate for Payer: Aetna Medicare |
$129.88
|
| Rate for Payer: ASR ASR |
$340.49
|
| Rate for Payer: BCBS Complete |
$140.41
|
| Rate for Payer: BCBS Trust/PPO |
$289.42
|
| Rate for Payer: BCN Commercial |
$289.42
|
| 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 |
$340.49
|
| Rate for Payer: Healthscope Whirlpool |
$351.02
|
| Rate for Payer: Mclaren Commercial |
$315.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$280.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.37
|
| Rate for Payer: Nomi Health Commercial |
$287.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$307.56
|
| Rate for Payer: Priority Health Narrow Network |
$246.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.90
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$3,465.34
|
|
|
Service Code
|
APR-DRG 3441
|
| Min. Negotiated Rate |
$3,133.08 |
| Max. Negotiated Rate |
$3,465.34 |
| Rate for Payer: BCBS Complete |
$3,465.34
|
| Rate for Payer: Mclaren Medicaid |
$3,300.32
|
| Rate for Payer: Meridian Medicaid |
$3,465.34
|
| Rate for Payer: PHP Medicaid |
$3,133.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,300.32
|
| Rate for Payer: UHC Medicaid |
$3,300.32
|
| Rate for Payer: UHCCP Medicaid |
$3,300.32
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$7,347.02
|
|
|
Service Code
|
APR-DRG 3443
|
| Min. Negotiated Rate |
$6,642.58 |
| Max. Negotiated Rate |
$7,347.02 |
| Rate for Payer: BCBS Complete |
$7,347.02
|
| Rate for Payer: Mclaren Medicaid |
$6,997.16
|
| Rate for Payer: Meridian Medicaid |
$7,347.02
|
| Rate for Payer: PHP Medicaid |
$6,642.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,997.16
|
| Rate for Payer: UHC Medicaid |
$6,997.16
|
| Rate for Payer: UHCCP Medicaid |
$6,997.16
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$8,955.71
|
|
|
Service Code
|
APR-DRG 3444
|
| Min. Negotiated Rate |
$8,097.03 |
| Max. Negotiated Rate |
$8,955.71 |
| Rate for Payer: BCBS Complete |
$8,955.71
|
| Rate for Payer: Mclaren Medicaid |
$8,529.25
|
| Rate for Payer: Meridian Medicaid |
$8,955.71
|
| Rate for Payer: PHP Medicaid |
$8,097.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,529.25
|
| Rate for Payer: UHC Medicaid |
$8,529.25
|
| Rate for Payer: UHCCP Medicaid |
$8,529.25
|
|
|
OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS
|
Facility
|
IP
|
$5,441.33
|
|
|
Service Code
|
APR-DRG 3442
|
| Min. Negotiated Rate |
$4,919.61 |
| Max. Negotiated Rate |
$5,441.33 |
| Rate for Payer: BCBS Complete |
$5,441.33
|
| Rate for Payer: Mclaren Medicaid |
$5,182.22
|
| Rate for Payer: Meridian Medicaid |
$5,441.33
|
| Rate for Payer: PHP Medicaid |
$4,919.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,182.22
|
| Rate for Payer: UHC Medicaid |
$5,182.22
|
| Rate for Payer: UHCCP Medicaid |
$5,182.22
|
|
|
OSTEOMYELITIS WITH CC
|
Facility
|
IP
|
$17,809.61
|
|
|
Service Code
|
MSDRG 540
|
| Min. Negotiated Rate |
$10,534.96 |
| Max. Negotiated Rate |
$17,809.61 |
| Rate for Payer: Aetna Medicare |
$11,089.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,861.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,861.79
|
| Rate for Payer: BCBS MAPPO |
$11,089.43
|
| Rate for Payer: BCN Medicare Advantage |
$11,089.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,089.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,089.43
|
| Rate for Payer: Mclaren Medicare |
$11,089.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,643.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,752.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,198.37
|
| Rate for Payer: PACE Medicare |
$10,534.96
|
| Rate for Payer: PACE SWMI |
$11,089.43
|
| Rate for Payer: PHP Commercial |
$12,198.37
|
| Rate for Payer: PHP Medicare Advantage |
$11,089.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,809.61
|
| Rate for Payer: Priority Health Medicare |
$11,089.43
|
| Rate for Payer: Priority Health Narrow Network |
$14,247.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,089.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,089.43
|
| Rate for Payer: UHC Exchange |
$17,188.62
|
| Rate for Payer: UHCCP DNSP |
$11,089.43
|
| Rate for Payer: VA VA |
$11,089.43
|
|
|
OSTEOMYELITIS WITH MCC
|
Facility
|
IP
|
$27,061.31
|
|
|
Service Code
|
MSDRG 539
|
| Min. Negotiated Rate |
$15,141.80 |
| Max. Negotiated Rate |
$27,061.31 |
| Rate for Payer: Aetna Medicare |
$15,938.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,923.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,923.42
|
| Rate for Payer: BCBS MAPPO |
$15,938.74
|
| Rate for Payer: BCN Medicare Advantage |
$15,938.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,938.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,938.74
|
| Rate for Payer: Mclaren Medicare |
$15,938.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,735.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,329.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,532.61
|
| Rate for Payer: PACE Medicare |
$15,141.80
|
| Rate for Payer: PACE SWMI |
$15,938.74
|
| Rate for Payer: PHP Commercial |
$17,532.61
|
| Rate for Payer: PHP Medicare Advantage |
$15,938.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,061.31
|
| Rate for Payer: Priority Health Medicare |
$15,938.74
|
| Rate for Payer: Priority Health Narrow Network |
$21,649.05
|
| Rate for Payer: Railroad Medicare Medicare |
$15,938.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,938.74
|
| Rate for Payer: UHC Exchange |
$24,705.05
|
| Rate for Payer: UHCCP DNSP |
$15,938.74
|
| Rate for Payer: VA VA |
$15,938.74
|
|
