|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$403.83
|
|
|
Service Code
|
NDC 11980077905
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.71 |
| Max. Negotiated Rate |
$363.45 |
| Rate for Payer: Aetna Commercial |
$343.26
|
| Rate for Payer: Aetna Medicare |
$201.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.49
|
| Rate for Payer: BCBS Complete |
$161.53
|
| Rate for Payer: Cash Price |
$323.06
|
| Rate for Payer: Cofinity Advantage |
$282.68
|
| Rate for Payer: Cofinity Commercial |
$347.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.06
|
| Rate for Payer: Healthscope Commercial |
$363.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$323.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.87
|
| Rate for Payer: PHP Commercial |
$343.26
|
| Rate for Payer: Priority Health SBD |
$254.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.49
|
| Rate for Payer: UHC Core |
$210.40
|
| Rate for Payer: UHC Exchange |
$158.71
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.25
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Advantage |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.91
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: Priority Health SBD |
$41.92
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$403.83
|
|
|
Service Code
|
NDC 11980077905
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.41 |
| Max. Negotiated Rate |
$363.45 |
| Rate for Payer: Aetna Commercial |
$343.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.49
|
| Rate for Payer: Cash Price |
$323.06
|
| Rate for Payer: Cofinity Advantage |
$282.68
|
| Rate for Payer: Cofinity Commercial |
$347.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.06
|
| Rate for Payer: Healthscope Commercial |
$363.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.87
|
| Rate for Payer: PHP Commercial |
$343.26
|
| Rate for Payer: Priority Health SBD |
$254.41
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$66.54
|
|
|
Service Code
|
NDC 24208043405
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$59.89 |
| Rate for Payer: Aetna Commercial |
$56.56
|
| Rate for Payer: Aetna Medicare |
$33.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.25
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: Cash Price |
$53.23
|
| Rate for Payer: Cofinity Advantage |
$46.58
|
| Rate for Payer: Cofinity Commercial |
$57.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.23
|
| Rate for Payer: Healthscope Commercial |
$59.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.91
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: Priority Health SBD |
$41.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.25
|
| Rate for Payer: UHC Core |
$34.67
|
| Rate for Payer: UHC Exchange |
$26.15
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Advantage |
$22.23
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.81
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health SBD |
$20.00
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.75
|
|
|
Service Code
|
NDC 17478071310
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$28.57 |
| Rate for Payer: Aetna Commercial |
$26.99
|
| Rate for Payer: Aetna Medicare |
$15.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.64
|
| Rate for Payer: BCBS Complete |
$12.70
|
| Rate for Payer: Cash Price |
$25.40
|
| Rate for Payer: Cofinity Advantage |
$22.23
|
| Rate for Payer: Cofinity Commercial |
$27.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.40
|
| Rate for Payer: Healthscope Commercial |
$28.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.81
|
| Rate for Payer: PHP Commercial |
$26.99
|
| Rate for Payer: Priority Health SBD |
$20.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$16.54
|
| Rate for Payer: UHC Exchange |
$12.48
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$902.43
|
|
|
Service Code
|
NDC 60505327600
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$568.53 |
| Max. Negotiated Rate |
$812.19 |
| Rate for Payer: Aetna Commercial |
$767.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.58
|
| Rate for Payer: Cash Price |
$721.94
|
| Rate for Payer: Cofinity Advantage |
$631.70
|
| Rate for Payer: Cofinity Commercial |
$776.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.94
|
| Rate for Payer: Healthscope Commercial |
$812.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$676.82
|
| Rate for Payer: PHP Commercial |
$767.07
|
| Rate for Payer: Priority Health SBD |
$568.53
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$119.13
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$107.22 |
| Rate for Payer: Aetna Commercial |
$101.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.43
|
| Rate for Payer: Cash Price |
$95.30
|
| Rate for Payer: Cofinity Advantage |
$83.39
|
| Rate for Payer: Cofinity Commercial |
$102.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.30
|
| Rate for Payer: Healthscope Commercial |
$107.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.35
|
| Rate for Payer: PHP Commercial |
$101.26
|
| Rate for Payer: Priority Health SBD |
$75.05
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$902.43
|
|
|
Service Code
|
NDC 60505327600
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.65 |
| Max. Negotiated Rate |
$812.19 |
| Rate for Payer: Aetna Commercial |
$767.07
|
| Rate for Payer: Aetna Medicare |
$451.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.58
|
| Rate for Payer: BCBS Complete |
$360.97
|
| Rate for Payer: Cash Price |
$721.94
|
| Rate for Payer: Cofinity Advantage |
$631.70
|
| Rate for Payer: Cofinity Commercial |
$776.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$721.94
|
| Rate for Payer: Healthscope Commercial |
$812.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$721.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$676.82
|
| Rate for Payer: PHP Commercial |
$767.07
|
| Rate for Payer: Priority Health SBD |
$568.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.58
|
| Rate for Payer: UHC Core |
$470.17
|
| Rate for Payer: UHC Exchange |
$354.65
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$168.34
|
|
|
Service Code
|
NDC 49884032155
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.16 |
| Max. Negotiated Rate |
$151.51 |
| Rate for Payer: Aetna Commercial |
$143.09
|
| Rate for Payer: Aetna Medicare |
$84.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.42
|
| Rate for Payer: BCBS Complete |
$67.34
|
| Rate for Payer: Cash Price |
$134.67
|
| Rate for Payer: Cofinity Advantage |
$117.84
|
| Rate for Payer: Cofinity Commercial |
$144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.67
|
| Rate for Payer: Healthscope Commercial |
$151.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.25
|
| Rate for Payer: PHP Commercial |
$143.09
|
| Rate for Payer: Priority Health SBD |
$106.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.42
|
| Rate for Payer: UHC Core |
$87.71
|
| Rate for Payer: UHC Exchange |
$66.16
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$5.62
|
|
|
Service Code
|
NDC 49884032152
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna Commercial |
$4.78
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$4.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.78
|
| Rate for Payer: Priority Health SBD |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$2.93
|
| Rate for Payer: UHC Exchange |
$2.21
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$119.13
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$107.22 |
| Rate for Payer: Aetna Commercial |
$101.26
|
| Rate for Payer: Aetna Medicare |
$59.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.43
|
| Rate for Payer: BCBS Complete |
$47.65
|
| Rate for Payer: Cash Price |
$95.30
|
| Rate for Payer: Cofinity Advantage |
$83.39
|
| Rate for Payer: Cofinity Commercial |
$102.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.30
|
| Rate for Payer: Healthscope Commercial |
$107.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.35
|
| Rate for Payer: PHP Commercial |
$101.26
|
| Rate for Payer: Priority Health SBD |
$75.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.43
|
| Rate for Payer: UHC Core |
$62.07
|
| Rate for Payer: UHC Exchange |
$46.82
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$168.34
|
|
|
Service Code
|
NDC 49884032155
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.05 |
| Max. Negotiated Rate |
$151.51 |
| Rate for Payer: Aetna Commercial |
$143.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.42
|
| Rate for Payer: Cash Price |
$134.67
|
| Rate for Payer: Cofinity Advantage |
$117.84
|
| Rate for Payer: Cofinity Commercial |
$144.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.67
|
| Rate for Payer: Healthscope Commercial |
$151.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.25
|
| Rate for Payer: PHP Commercial |
$143.09
|
| Rate for Payer: Priority Health SBD |
$106.05
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$5.62
|
|
|
Service Code
|
NDC 49884032152
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna Commercial |
$4.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$4.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.78
|
| Rate for Payer: Priority Health SBD |
$3.54
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$64.80
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.82 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cofinity Advantage |
$37.72
|
| Rate for Payer: Cofinity Advantage |
$37.67
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Advantage |
$31.87
|
| Rate for Payer: Cofinity Advantage |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Priority Health SBD |
$29.72
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: Priority Health SBD |
$40.82
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$64.80
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$22.77
|
| Rate for Payer: Aetna Medicare |
$23.59
|
| Rate for Payer: Aetna Medicare |
$26.91
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: BCBS Complete |
$25.92
|
| Rate for Payer: BCBS Complete |
$18.87
|
| Rate for Payer: BCBS Complete |
$21.52
|
| Rate for Payer: BCBS Complete |
$18.21
|
| Rate for Payer: BCBS Complete |
$21.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$37.74
|
| Rate for Payer: Cash Price |
$43.05
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Advantage |
$37.72
|
| Rate for Payer: Cofinity Advantage |
$33.02
|
| Rate for Payer: Cofinity Advantage |
$31.87
|
| Rate for Payer: Cofinity Advantage |
$37.67
|
| Rate for Payer: Cofinity Commercial |
$46.28
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.74
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$48.43
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.42
|
| Rate for Payer: PHP Commercial |
$45.74
|
| Rate for Payer: PHP Commercial |
$40.09
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: Priority Health SBD |
$33.90
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: Priority Health SBD |
$29.72
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00904637661
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00904637661
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Advantage |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.79
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: Priority Health SBD |
$4.86
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$115.20
|
|
|
Service Code
|
NDC 59746030632
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.27 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$97.92
|
| Rate for Payer: Aetna Medicare |
$57.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.88
|
| Rate for Payer: BCBS Complete |
$46.08
|
| Rate for Payer: Cash Price |
$92.16
|
| Rate for Payer: Cofinity Advantage |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$99.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.16
|
| Rate for Payer: Healthscope Commercial |
$103.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.40
|
| Rate for Payer: PHP Commercial |
$97.92
|
| Rate for Payer: Priority Health SBD |
$72.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.88
|
| Rate for Payer: UHC Core |
$60.02
|
| Rate for Payer: UHC Exchange |
$45.27
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$65.27
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Advantage |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$56.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.95
|
| Rate for Payer: PHP Commercial |
$55.48
|
| Rate for Payer: Priority Health SBD |
$41.12
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$796.80
|
|
|
Service Code
|
NDC 60505327500
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$501.98 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$677.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.92
|
| Rate for Payer: Cash Price |
$637.44
|
| Rate for Payer: Cofinity Advantage |
$557.76
|
| Rate for Payer: Cofinity Commercial |
$685.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.44
|
| Rate for Payer: Healthscope Commercial |
$717.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.60
|
| Rate for Payer: PHP Commercial |
$677.28
|
| Rate for Payer: Priority Health SBD |
$501.98
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$115.20
|
|
|
Service Code
|
NDC 59746030632
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.58 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.88
|
| Rate for Payer: Cash Price |
$92.16
|
| Rate for Payer: Cofinity Advantage |
$80.64
|
| Rate for Payer: Cofinity Commercial |
$99.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.16
|
| Rate for Payer: Healthscope Commercial |
$103.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.40
|
| Rate for Payer: PHP Commercial |
$97.92
|
| Rate for Payer: Priority Health SBD |
$72.58
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$65.27
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare |
$32.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Advantage |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$56.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.95
|
| Rate for Payer: PHP Commercial |
$55.48
|
| Rate for Payer: Priority Health SBD |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.43
|
| Rate for Payer: UHC Core |
$34.01
|
| Rate for Payer: UHC Exchange |
$25.65
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$231.56
|
|
|
Service Code
|
NDC 55111026281
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$208.40 |
| Rate for Payer: Aetna Commercial |
$196.83
|
| Rate for Payer: Aetna Medicare |
$115.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.51
|
| Rate for Payer: BCBS Complete |
$92.62
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cofinity Advantage |
$162.09
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.25
|
| Rate for Payer: Healthscope Commercial |
$208.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.67
|
| Rate for Payer: PHP Commercial |
$196.83
|
| Rate for Payer: Priority Health SBD |
$145.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.51
|
| Rate for Payer: UHC Core |
$120.64
|
| Rate for Payer: UHC Exchange |
$91.00
|
|
