St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ORTHO SCREW NONLOCKING 2.4

Facility

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64907037
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$485.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$277.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$231.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$265.94
Rate for Payer: EmblemHealth Commercial	$231.25
Rate for Payer: Fidelis Medicare Advantage	$485.62
Rate for Payer: Group Health Inc Commercial	$231.25
Rate for Payer: Group Health Inc Medicare	$161.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$300.62

ORTHO SCREW NONLOCKING 2.4

Facility

$462.50

Service Code	HCPCS C1713
Hospital Charge Code	64907037
Hospital Revenue Code	278
Min. Negotiated Rate	$231.25
Max. Negotiated Rate	$231.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.25
Rate for Payer: Hamaspik Choice Inc Medicare	$231.25

ORTHO SOLAR HUM HEAD 40MMX15MM

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Charge Code	40202367
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.00
Max. Negotiated Rate	$1,644.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,644.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,644.00

ORTHO SOLAR HUM HEAD 40MMX15MM

Facility

$3,288.00

Service Code	HCPCS C1776
Hospital Charge Code	40202367
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,452.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,808.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,972.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,644.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,890.60
Rate for Payer: EmblemHealth Commercial	$1,644.00
Rate for Payer: Fidelis Medicare Advantage	$3,452.40
Rate for Payer: Group Health Inc Commercial	$1,644.00
Rate for Payer: Group Health Inc Medicare	$1,150.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,644.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,644.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,137.20

ORTHOSORB RESORB PIN 50MMX1.3MM

Facility

$404.92

Service Code	HCPCS C1776
Hospital Charge Code	40200933
Hospital Revenue Code	278
Min. Negotiated Rate	$141.72
Max. Negotiated Rate	$425.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$222.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$242.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$202.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$232.83
Rate for Payer: EmblemHealth Commercial	$202.46
Rate for Payer: Fidelis Medicare Advantage	$425.17
Rate for Payer: Group Health Inc Commercial	$202.46
Rate for Payer: Group Health Inc Medicare	$141.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.46
Rate for Payer: Hamaspik Choice Inc Medicare	$202.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$263.20

ORTHOSORB RESORB PIN 50MMX1.3MM

Facility

$404.92

Service Code	HCPCS C1776
Hospital Charge Code	40200933
Hospital Revenue Code	278
Min. Negotiated Rate	$202.46
Max. Negotiated Rate	$202.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$202.46
Rate for Payer: Hamaspik Choice Inc Medicare	$202.46

ORTHOSTAT 2.0GRAM

Facility

$650.00

Hospital Charge Code	64904807
Hospital Revenue Code	270
Min. Negotiated Rate	$227.50
Max. Negotiated Rate	$520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$357.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$325.00
Rate for Payer: Aetna Government	$325.00
Rate for Payer: Brighton Health Commercial	$487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$442.00
Rate for Payer: Group Health Inc Commercial	$325.00
Rate for Payer: Group Health Inc Medicare	$227.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$325.00
Rate for Payer: Hamaspik Choice Inc Medicare	$325.00

ORTHO THREAD TIP WIRE 3.2MM

Facility

$406.00

Hospital Charge Code	40203551
Hospital Revenue Code	272
Min. Negotiated Rate	$142.10
Max. Negotiated Rate	$324.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$223.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$203.00
Rate for Payer: Aetna Government	$203.00
Rate for Payer: Brighton Health Commercial	$304.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$324.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.08
Rate for Payer: Group Health Inc Commercial	$203.00
Rate for Payer: Group Health Inc Medicare	$142.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$203.00
Rate for Payer: Hamaspik Choice Inc Medicare	$203.00

ORTHOTIC MGMT AND TRAINING

Facility

$145.48

Service Code	HCPCS 97760
Hospital Charge Code	30303085
Hospital Revenue Code	420
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$4,788.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$80.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.95
Rate for Payer: Aetna Government	$22.95
Rate for Payer: Affinity Essential Plan 1&2	$107.73
Rate for Payer: Affinity Essential Plan 3&4	$107.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$47.88
Rate for Payer: Amida Care Medicaid	$47.88
Rate for Payer: Brighton Health Commercial	$182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$124.95
Rate for Payer: Fidelis CHP/HARP/Medicaid	$4,788.00
Rate for Payer: Fidelis Essential Plan Aliesa	$47.88
Rate for Payer: Fidelis Essential Plan QHP	$47.88
Rate for Payer: Fidelis Qualified Health Plan	$50.27
Rate for Payer: Group Health Inc Commercial	$72.74
Rate for Payer: Group Health Inc Medicare	$120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.88
Rate for Payer: Hamaspik Choice Inc Medicare	$72.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$47.88
Rate for Payer: Healthfirst Essential Plan	$107.73
Rate for Payer: Healthfirst QHP	$47.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.88
Rate for Payer: SOMOS Essential	$107.73
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$107.73
Rate for Payer: United Healthcare Essential Plan 3&4	$52.67
Rate for Payer: United Healthcare Medicaid	$47.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$47.88
Rate for Payer: Wellcare Medicare	$55.00

ORTHO TX BY ANOTHER ORTHODONTIST

Facility

$1,100.00

Service Code	HCPCS D8690
Hospital Charge Code	42303371
Hospital Revenue Code	361
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.00
Rate for Payer: Aetna Government	$550.00
Rate for Payer: Brighton Health Commercial	$825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

ORTV VTS BA2X BN BLK 10CC SYN CAN

Facility

$8,137.50

Service Code	HCPCS C1713
Hospital Charge Code	40204708
Hospital Revenue Code	278
Min. Negotiated Rate	$4,068.75
Max. Negotiated Rate	$4,068.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,068.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,068.75

ORTV VTS BA2X BN BLK 10CC SYN CAN

Facility

$8,137.50

Service Code	HCPCS C1713
Hospital Charge Code	40204708
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,544.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,475.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,882.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,068.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,679.06
Rate for Payer: EmblemHealth Commercial	$4,068.75
Rate for Payer: Fidelis Medicare Advantage	$8,544.38
Rate for Payer: Group Health Inc Commercial	$4,068.75
Rate for Payer: Group Health Inc Medicare	$2,848.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,068.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,068.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,289.38

OSELTAMIVIR 12 MG/ML SUSP

Facility

$4.00

Hospital Charge Code	41654262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

OSELTAMIVIR 12 MG/ML SUSP

Facility

$4.00

Hospital Charge Code	41644262
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

OSELTAMIVIR 30 MG CAP

Facility

$17.00

Hospital Charge Code	41654844
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Brighton Health Commercial	$12.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

OSELTAMIVIR 30 MG CAP

Facility

$17.00

Hospital Charge Code	41644844
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Brighton Health Commercial	$12.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

OSELTAMIVIR 45 MG CAP

Facility

$18.43

Hospital Charge Code	41645258
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$14.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.22
Rate for Payer: Aetna Government	$9.22
Rate for Payer: Brighton Health Commercial	$13.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.53
Rate for Payer: Group Health Inc Commercial	$9.22
Rate for Payer: Group Health Inc Medicare	$6.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.22
Rate for Payer: Hamaspik Choice Inc Medicare	$9.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.98

OSELTAMIVIR 45 MG CAP

Facility

$18.43

Hospital Charge Code	41655258
Hospital Revenue Code	250
Min. Negotiated Rate	$6.45
Max. Negotiated Rate	$14.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.22
Rate for Payer: Aetna Government	$9.22
Rate for Payer: Brighton Health Commercial	$13.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.53
Rate for Payer: Group Health Inc Commercial	$9.22
Rate for Payer: Group Health Inc Medicare	$6.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.22
Rate for Payer: Hamaspik Choice Inc Medicare	$9.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.98

OSELTAMIVIR 6MG/ML ORAL

Facility

$4.00

Hospital Charge Code	41656016
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

OSELTAMIVIR 6MG/ML ORAL

Facility

$4.00

Hospital Charge Code	41646016
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

OSELTAMIVIR 75 MG CAP

Facility

$17.00

Hospital Charge Code	41655143
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Brighton Health Commercial	$12.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

OSELTAMIVIR 75 MG CAP

Facility

$17.00

Hospital Charge Code	41645143
Hospital Revenue Code	250
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Brighton Health Commercial	$12.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.56
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]

Facility

$14.18

Service Code	NDC 47781046813
Hospital Charge Code	47781046813
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]

Facility

$14.18

Service Code	NDC 72205004211
Hospital Charge Code	72205004211
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

OSELTAMIVIR PHOSPHATE 30 MG PO CAPS [88704]

Facility

$14.18

Service Code	NDC 68180067511
Hospital Charge Code	68180067511
Hospital Revenue Code	250
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.09
Rate for Payer: Aetna Government	$7.09
Rate for Payer: Brighton Health Commercial	$10.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.64
Rate for Payer: Group Health Inc Commercial	$7.09
Rate for Payer: Group Health Inc Medicare	$4.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.09
Rate for Payer: Hamaspik Choice Inc Medicare	$7.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.22

Know your out-of-pocket cost for care.

All Charges