|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 59746030612
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Advantage |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.88
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.42
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$231.56
|
|
|
Service Code
|
NDC 55111026281
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$208.40 |
| Rate for Payer: Aetna Commercial |
$196.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.51
|
| 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: 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
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: BCBS Complete |
$3.09
|
| 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: MI Amish Medical Board Commercial |
$6.18
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$4.02
|
| Rate for Payer: UHC Exchange |
$3.03
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$796.80
|
|
|
Service Code
|
NDC 60505327500
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.14 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna Commercial |
$677.28
|
| Rate for Payer: Aetna Medicare |
$398.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.92
|
| Rate for Payer: BCBS Complete |
$318.72
|
| 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: MI Amish Medical Board Commercial |
$637.44
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.92
|
| Rate for Payer: UHC Core |
$415.13
|
| Rate for Payer: UHC Exchange |
$313.14
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 59746030612
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Advantage |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.88
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.50
|
| Rate for Payer: UHC Core |
$2.00
|
| Rate for Payer: UHC Exchange |
$1.51
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.47 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.06 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 68084072311
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Advantage |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.15
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.30
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 68084072311
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Advantage |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.08
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$20.57
|
|
|
Service Code
|
NDC 00536144540
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Advantage |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.43
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health SBD |
$12.96
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$20.57
|
|
|
Service Code
|
NDC 00536130840
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Advantage |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.43
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health SBD |
$12.96
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$20.57
|
|
|
Service Code
|
NDC 00536144540
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Advantage |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.43
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.37
|
| Rate for Payer: UHC Core |
$10.72
|
| Rate for Payer: UHC Exchange |
$8.08
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$20.57
|
|
|
Service Code
|
NDC 00536130840
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.37
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Advantage |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.43
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health SBD |
$12.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.37
|
| Rate for Payer: UHC Core |
$10.72
|
| Rate for Payer: UHC Exchange |
$8.08
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$114.13
|
| Rate for Payer: BCN Commercial |
$114.13
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Mclaren Medicaid |
$21.87
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,132.39 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,132.39 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$114.13
|
| Rate for Payer: BCN Commercial |
$114.13
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Mclaren Medicaid |
$21.87
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$2,265.80
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$2,039.22 |
| Rate for Payer: Aetna Commercial |
$1,925.93
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$114.13
|
| Rate for Payer: BCN Commercial |
$114.13
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cofinity Advantage |
$1,586.06
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$2,039.22
|
| Rate for Payer: Mclaren Medicaid |
$21.87
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.35
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$2,265.80
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,427.45 |
| Max. Negotiated Rate |
$2,039.22 |
| Rate for Payer: Aetna Commercial |
$1,925.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cofinity Advantage |
$1,586.06
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.64
|
| Rate for Payer: Healthscope Commercial |
$2,039.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.35
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$434.88
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.91 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: Aetna Medicare |
$217.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.67
|
| Rate for Payer: BCBS Complete |
$173.95
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cofinity Advantage |
$304.42
|
| Rate for Payer: Cofinity Commercial |
$374.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.90
|
| Rate for Payer: Healthscope Commercial |
$391.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.16
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health SBD |
$273.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.67
|
| Rate for Payer: UHC Core |
$226.57
|
| Rate for Payer: UHC Exchange |
$170.91
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
NDC 60687012711
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna Commercial |
$8.25
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.31
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Cofinity Advantage |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$8.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.77
|
| Rate for Payer: Healthscope Commercial |
$8.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.28
|
| Rate for Payer: PHP Commercial |
$8.25
|
| Rate for Payer: Priority Health SBD |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.31
|
| Rate for Payer: UHC Core |
$5.06
|
| Rate for Payer: UHC Exchange |
$3.82
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$485.07
|
|
|
Service Code
|
NDC 60687012765
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.63 |
| Max. Negotiated Rate |
$436.56 |
| Rate for Payer: Aetna Commercial |
$412.31
|
| Rate for Payer: Aetna Medicare |
$242.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.30
|
| Rate for Payer: BCBS Complete |
$194.03
|
| Rate for Payer: Cash Price |
$388.06
|
| Rate for Payer: Cofinity Advantage |
$339.55
|
| Rate for Payer: Cofinity Commercial |
$417.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.06
|
| Rate for Payer: Healthscope Commercial |
$436.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$388.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.80
|
| Rate for Payer: PHP Commercial |
$412.31
|
| Rate for Payer: Priority Health SBD |
$305.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.30
|
| Rate for Payer: UHC Core |
$252.72
|
| Rate for Payer: UHC Exchange |
$190.63
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$495.43
|
|
|
Service Code
|
NDC 00904749506
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.70 |
| Max. Negotiated Rate |
$445.89 |
| Rate for Payer: Aetna Commercial |
$421.12
|
| Rate for Payer: Aetna Medicare |
$247.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.03
|
| Rate for Payer: BCBS Complete |
$198.17
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Cofinity Advantage |
$346.80
|
| Rate for Payer: Cofinity Commercial |
$426.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.34
|
| Rate for Payer: Healthscope Commercial |
$445.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.57
|
| Rate for Payer: PHP Commercial |
$421.12
|
| Rate for Payer: Priority Health SBD |
$312.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.03
|
| Rate for Payer: UHC Core |
$258.12
|
| Rate for Payer: UHC Exchange |
$194.70
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$440.86
|
|
|
Service Code
|
NDC 00904670606
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.26 |
| Max. Negotiated Rate |
$396.77 |
| Rate for Payer: Aetna Commercial |
$374.73
|
| Rate for Payer: Aetna Medicare |
$220.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.56
|
| Rate for Payer: BCBS Complete |
$176.34
|
| Rate for Payer: Cash Price |
$352.69
|
| Rate for Payer: Cofinity Advantage |
$308.60
|
| Rate for Payer: Cofinity Commercial |
$379.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.69
|
| Rate for Payer: Healthscope Commercial |
$396.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.64
|
| Rate for Payer: PHP Commercial |
$374.73
|
| Rate for Payer: Priority Health SBD |
$277.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.56
|
| Rate for Payer: UHC Core |
$229.69
|
| Rate for Payer: UHC Exchange |
$173.26
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$547.08
|
|
|
Service Code
|
NDC 42806055212
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.66 |
| Max. Negotiated Rate |
$492.37 |
| Rate for Payer: Aetna Commercial |
$465.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: Cash Price |
$437.66
|
| Rate for Payer: Cofinity Advantage |
$382.96
|
| Rate for Payer: Cofinity Commercial |
$470.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.66
|
| Rate for Payer: Healthscope Commercial |
$492.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.31
|
| Rate for Payer: PHP Commercial |
$465.02
|
| Rate for Payer: Priority Health SBD |
$344.66
|
|
