|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.48
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.66 |
| Max. Negotiated Rate |
$479.48 |
| Rate for Payer: Aetna Commercial |
$431.53
|
| Rate for Payer: ASR ASR |
$465.10
|
| Rate for Payer: ASR Commercial |
$465.10
|
| Rate for Payer: BCBS Trust/PPO |
$390.73
|
| 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 Commercial |
$407.56
|
| Rate for Payer: Nomi Health Commercial |
$393.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.94
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.33 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$289.84
|
| Rate for Payer: ASR ASR |
$312.39
|
| Rate for Payer: ASR Commercial |
$312.39
|
| Rate for Payer: BCBS Trust/PPO |
$262.44
|
| 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 Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.40
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$479.48
|
|
|
Service Code
|
NDC 00004080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.79 |
| Max. Negotiated Rate |
$479.48 |
| Rate for Payer: Aetna Commercial |
$431.53
|
| Rate for Payer: Aetna Medicare |
$239.74
|
| Rate for Payer: ASR ASR |
$465.10
|
| Rate for Payer: ASR Commercial |
$465.10
|
| Rate for Payer: BCBS Complete |
$191.79
|
| Rate for Payer: BCBS Trust/PPO |
$392.65
|
| 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 Commercial |
$407.56
|
| Rate for Payer: Nomi Health Commercial |
$393.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$420.12
|
| Rate for Payer: Priority Health Narrow Network |
$336.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.94
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$39.17
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.67 |
| Max. Negotiated Rate |
$39.17 |
| Rate for Payer: Aetna Commercial |
$35.25
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: ASR ASR |
$37.99
|
| Rate for Payer: ASR Commercial |
$37.99
|
| Rate for Payer: BCBS Complete |
$15.67
|
| Rate for Payer: BCBS Trust/PPO |
$32.08
|
| Rate for Payer: BCN Commercial |
$30.37
|
| Rate for Payer: Cash Price |
$31.33
|
| Rate for Payer: Cofinity Commercial |
$36.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.34
|
| Rate for Payer: Healthscope Commercial |
$39.17
|
| Rate for Payer: Healthscope Whirlpool |
$37.99
|
| Rate for Payer: Mclaren Commercial |
$35.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.29
|
| Rate for Payer: Nomi Health Commercial |
$32.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.32
|
| Rate for Payer: Priority Health Narrow Network |
$27.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.47
|
|
|
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 |
$290.91 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: ASR ASR |
$434.12
|
| Rate for Payer: ASR Commercial |
$434.12
|
| Rate for Payer: BCBS Trust/PPO |
$364.71
|
| 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 Commercial |
$380.42
|
| Rate for Payer: Nomi Health Commercial |
$366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.84
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$522.59
|
|
|
Service Code
|
NDC 00004082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.04 |
| Max. Negotiated Rate |
$522.59 |
| Rate for Payer: Aetna Commercial |
$470.33
|
| Rate for Payer: Aetna Medicare |
$261.30
|
| Rate for Payer: ASR ASR |
$506.91
|
| Rate for Payer: ASR Commercial |
$506.91
|
| Rate for Payer: BCBS Complete |
$209.04
|
| Rate for Payer: BCBS Trust/PPO |
$427.95
|
| 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 Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$457.89
|
| Rate for Payer: Priority Health Narrow Network |
$366.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.88
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.05 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$207.76
|
| Rate for Payer: ASR ASR |
$223.92
|
| Rate for Payer: ASR Commercial |
$223.92
|
| Rate for Payer: BCBS Trust/PPO |
$188.12
|
| Rate for Payer: BCN Commercial |
$178.98
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$217.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Healthscope Whirlpool |
$223.92
|
| Rate for Payer: Mclaren Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.15
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$522.59
|
|
|
Service Code
|
NDC 00004082205
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$522.59 |
| Rate for Payer: Aetna Commercial |
$470.33
|
| Rate for Payer: ASR ASR |
$506.91
|
| Rate for Payer: ASR Commercial |
$506.91
|
| Rate for Payer: BCBS Trust/PPO |
$425.86
|
| 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 Commercial |
$444.20
|
| Rate for Payer: Nomi Health Commercial |
$428.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.88
|
|
|
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 |
$179.02 |
| Max. Negotiated Rate |
$447.55 |
| Rate for Payer: Aetna Commercial |
$402.80
|
| Rate for Payer: Aetna Medicare |
$223.78
|
| Rate for Payer: ASR ASR |
$434.12
|
| Rate for Payer: ASR Commercial |
$434.12
|
| Rate for Payer: BCBS Complete |
$179.02
|
| Rate for Payer: BCBS Trust/PPO |
$366.50
|
| 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 Commercial |
$380.42
|
| Rate for Payer: Nomi Health Commercial |
$366.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.14
|
| Rate for Payer: Priority Health Narrow Network |
$313.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$393.84
|
|
|
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 68180067801
|
| Hospital Charge Code |
153071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$207.76
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: ASR ASR |
$223.92
|
| Rate for Payer: ASR Commercial |
$223.92
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: BCBS Trust/PPO |
$189.04
|
| Rate for Payer: BCN Commercial |
$178.98
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$217.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$230.85
|
| Rate for Payer: Healthscope Whirlpool |
$223.92
|
| Rate for Payer: Mclaren Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Nomi Health Commercial |
$189.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.27
|
| Rate for Payer: Priority Health Narrow Network |
$161.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.15
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$276.20
|
|
|
Service Code
|
NDC 70710101002
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.53 |
| Max. Negotiated Rate |
$276.20 |
| Rate for Payer: Aetna Commercial |
$248.58
|
| Rate for Payer: ASR ASR |
$267.91
|
| Rate for Payer: ASR Commercial |
$267.91
|
| Rate for Payer: BCBS Trust/PPO |
$225.08
|
| 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 Commercial |
$234.77
|
| Rate for Payer: Nomi Health Commercial |
$226.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.06
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.62
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.70 |
| Max. Negotiated Rate |
$522.62 |
| Rate for Payer: Aetna Commercial |
$470.36
|
| Rate for Payer: ASR ASR |
$506.94
|
| Rate for Payer: ASR Commercial |
$506.94
|
| Rate for Payer: BCBS Trust/PPO |
$425.88
|
| 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 Commercial |
$444.23
|
| Rate for Payer: Nomi Health Commercial |
$428.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$459.91
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.62
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$522.62 |
| Rate for Payer: Aetna Commercial |
$470.36
|
| Rate for Payer: Aetna Medicare |
$261.31
|
| Rate for Payer: ASR ASR |
$506.94
|
| Rate for Payer: ASR Commercial |
$506.94
|
| Rate for Payer: BCBS Complete |
$209.05
|
| Rate for Payer: BCBS Trust/PPO |
$427.97
|
| 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 Commercial |
$444.23
|
| Rate for Payer: Nomi Health Commercial |
$428.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.70
|
| Rate for Payer: 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
|
OP
|
$351.02
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.41 |
| Max. Negotiated Rate |
$351.02 |
| Rate for Payer: Aetna Commercial |
$315.92
|
| Rate for Payer: Aetna Medicare |
$175.51
|
| Rate for Payer: ASR ASR |
$340.49
|
| Rate for Payer: ASR Commercial |
$340.49
|
| Rate for Payer: BCBS Complete |
$140.41
|
| Rate for Payer: BCBS Trust/PPO |
$287.45
|
| 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 Commercial |
$298.37
|
| Rate for Payer: Nomi Health Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.56
|
| Rate for Payer: Priority Health Narrow Network |
$246.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.90
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$275.24
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.10 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: Aetna Medicare |
$137.62
|
| Rate for Payer: ASR ASR |
$266.98
|
| Rate for Payer: ASR Commercial |
$266.98
|
| Rate for Payer: BCBS Complete |
$110.10
|
| Rate for Payer: BCBS Trust/PPO |
$225.39
|
| 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 Commercial |
$233.95
|
| Rate for Payer: Nomi Health Commercial |
$225.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.17
|
| Rate for Payer: Priority Health Narrow Network |
$192.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.21
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$276.20
|
|
|
Service Code
|
NDC 70710101002
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.48 |
| Max. Negotiated Rate |
$276.20 |
| Rate for Payer: Aetna Commercial |
$248.58
|
| Rate for Payer: Aetna Medicare |
$138.10
|
| Rate for Payer: ASR ASR |
$267.91
|
| Rate for Payer: ASR Commercial |
$267.91
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: BCBS Trust/PPO |
$226.18
|
| 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 Commercial |
$234.77
|
| Rate for Payer: Nomi Health Commercial |
$226.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.01
|
| Rate for Payer: Priority Health Narrow Network |
$193.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.06
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$275.24
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.91 |
| Max. Negotiated Rate |
$275.24 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: ASR ASR |
$266.98
|
| Rate for Payer: ASR Commercial |
$266.98
|
| Rate for Payer: BCBS Trust/PPO |
$224.29
|
| 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 Commercial |
$233.95
|
| Rate for Payer: Nomi Health Commercial |
$225.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.21
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$53.95
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$48.56
|
| Rate for Payer: ASR ASR |
$52.33
|
| Rate for Payer: ASR Commercial |
$52.33
|
| Rate for Payer: BCBS Trust/PPO |
$43.96
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$53.95
|
| Rate for Payer: Healthscope Whirlpool |
$52.33
|
| Rate for Payer: Mclaren Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.86
|
| Rate for Payer: Nomi Health Commercial |
$44.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.48
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$53.95
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.58 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$48.56
|
| Rate for Payer: Aetna Medicare |
$26.98
|
| Rate for Payer: ASR ASR |
$52.33
|
| Rate for Payer: ASR Commercial |
$52.33
|
| Rate for Payer: BCBS Complete |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$44.18
|
| Rate for Payer: BCN Commercial |
$41.83
|
| Rate for Payer: Cash Price |
$43.16
|
| Rate for Payer: Cofinity Commercial |
$50.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.16
|
| Rate for Payer: Healthscope Commercial |
$53.95
|
| Rate for Payer: Healthscope Whirlpool |
$52.33
|
| Rate for Payer: Mclaren Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.86
|
| Rate for Payer: Nomi Health Commercial |
$44.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.27
|
| Rate for Payer: Priority Health Narrow Network |
$37.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.48
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$351.02
|
|
|
Service Code
|
NDC 47781047013
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.16 |
| Max. Negotiated Rate |
$351.02 |
| Rate for Payer: Aetna Commercial |
$315.92
|
| Rate for Payer: ASR ASR |
$340.49
|
| Rate for Payer: ASR Commercial |
$340.49
|
| Rate for Payer: BCBS Trust/PPO |
$286.05
|
| 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 Commercial |
$298.37
|
| Rate for Payer: Nomi Health Commercial |
$287.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.90
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.06 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$268.70
|
| Rate for Payer: ASR ASR |
$289.60
|
| Rate for Payer: ASR Commercial |
$289.60
|
| Rate for Payer: BCBS Trust/PPO |
$243.30
|
| Rate for Payer: BCN Commercial |
$231.47
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$298.56
|
| Rate for Payer: Healthscope Whirlpool |
$289.60
|
| Rate for Payer: Mclaren Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.73
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: ASR ASR |
$2.90
|
| Rate for Payer: ASR Commercial |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.44
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Mclaren Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Nomi Health Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.63
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$298.56
|
|
|
Service Code
|
NDC 68084085301
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.42 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$268.70
|
| Rate for Payer: Aetna Medicare |
$149.28
|
| Rate for Payer: ASR ASR |
$289.60
|
| Rate for Payer: ASR Commercial |
$289.60
|
| Rate for Payer: BCBS Complete |
$119.42
|
| Rate for Payer: BCBS Trust/PPO |
$244.49
|
| Rate for Payer: BCN Commercial |
$231.47
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$298.56
|
| Rate for Payer: Healthscope Whirlpool |
$289.60
|
| Rate for Payer: Mclaren Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.78
|
| Rate for Payer: Nomi Health Commercial |
$244.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.60
|
| Rate for Payer: Priority Health Narrow Network |
$209.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.73
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
NDC 68084085311
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: ASR ASR |
$2.90
|
| Rate for Payer: ASR Commercial |
$2.90
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS Trust/PPO |
$2.45
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Mclaren Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.54
|
| Rate for Payer: Nomi Health Commercial |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.62
|
| Rate for Payer: Priority Health Narrow Network |
$2.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.63
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 00904282161
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.80 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna Commercial |
$293.26
|
| Rate for Payer: ASR ASR |
$316.07
|
| Rate for Payer: ASR Commercial |
$316.07
|
| Rate for Payer: BCBS Trust/PPO |
$265.54
|
| Rate for Payer: BCN Commercial |
$252.63
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$325.85
|
| Rate for Payer: Healthscope Whirlpool |
$316.07
|
| Rate for Payer: Mclaren Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.97
|
| Rate for Payer: Nomi Health Commercial |
$267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.75
|
|
