Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OFLOXACIN 0.3 % EYE DROPS

Facility

$66.54

Service Code	NDC 24208043405
Hospital Charge Code	19746
Hospital Revenue Code	637
Min. Negotiated Rate	$26.62
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 Commercial	$46.58
Rate for Payer: Cofinity Commercial	$57.22
Rate for Payer: Cofinity Medicare Advantage	$46.58
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: PHP Commercial	$56.56
Rate for Payer: Priority Health Cigna Priority Health	$43.25
Rate for Payer: Priority Health SBD	$41.92

OFLOXACIN 0.3 % EYE DROPS

Facility

$403.83

Service Code	NDC 11980077905
Hospital Charge Code	19746
Hospital Revenue Code	637
Min. Negotiated Rate	$161.53
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 Commercial	$282.68
Rate for Payer: Cofinity Commercial	$347.29
Rate for Payer: Cofinity Medicare Advantage	$282.68
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: PHP Commercial	$343.26
Rate for Payer: Priority Health Cigna Priority Health	$262.49
Rate for Payer: Priority Health SBD	$254.41

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$118.56

Service Code	NDC 33342008407
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$74.69
Max. Negotiated Rate	$106.70
Rate for Payer: Aetna Commercial	$100.78
Rate for Payer: Aetna New Business (MI Preferred)	$77.06
Rate for Payer: Cash Price	$94.85
Rate for Payer: Cofinity Commercial	$101.96
Rate for Payer: Cofinity Commercial	$82.99
Rate for Payer: Cofinity Medicare Advantage	$82.99
Rate for Payer: Encore Health Key Benefits Commercial	$94.85
Rate for Payer: Healthscope Commercial	$106.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.78
Rate for Payer: PHP Commercial	$100.78
Rate for Payer: Priority Health Cigna Priority Health	$77.06
Rate for Payer: Priority Health SBD	$74.69

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$3.93
Rate for Payer: Cofinity Commercial	$4.83
Rate for Payer: Cofinity Medicare Advantage	$3.93
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: PHP Commercial	$4.78
Rate for Payer: Priority Health Cigna Priority Health	$3.65
Rate for Payer: Priority Health SBD	$3.54

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$118.56

Service Code	NDC 33342008407
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$47.42
Max. Negotiated Rate	$106.70
Rate for Payer: Aetna Commercial	$100.78
Rate for Payer: Aetna Medicare	$59.28
Rate for Payer: Aetna New Business (MI Preferred)	$77.06
Rate for Payer: BCBS Complete	$47.42
Rate for Payer: Cash Price	$94.85
Rate for Payer: Cofinity Commercial	$101.96
Rate for Payer: Cofinity Commercial	$82.99
Rate for Payer: Cofinity Medicare Advantage	$82.99
Rate for Payer: Encore Health Key Benefits Commercial	$94.85
Rate for Payer: Healthscope Commercial	$106.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.78
Rate for Payer: PHP Commercial	$100.78
Rate for Payer: Priority Health Cigna Priority Health	$77.06
Rate for Payer: Priority Health SBD	$74.69

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$902.43

Service Code	NDC 60505327600
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$360.97
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 Commercial	$631.70
Rate for Payer: Cofinity Commercial	$776.09
Rate for Payer: Cofinity Medicare Advantage	$631.70
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: PHP Commercial	$767.07
Rate for Payer: Priority Health Cigna Priority Health	$586.58
Rate for Payer: Priority Health SBD	$568.53

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$631.70
Rate for Payer: Cofinity Commercial	$776.09
Rate for Payer: Cofinity Medicare Advantage	$631.70
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: PHP Commercial	$767.07
Rate for Payer: Priority Health Cigna Priority Health	$586.58
Rate for Payer: Priority Health SBD	$568.53

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$168.34

Service Code	NDC 49884032155
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$67.34
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 Commercial	$117.84
Rate for Payer: Cofinity Commercial	$144.77
Rate for Payer: Cofinity Medicare Advantage	$117.84
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: PHP Commercial	$143.09
Rate for Payer: Priority Health Cigna Priority Health	$109.42
Rate for Payer: Priority Health SBD	$106.05

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$117.84
Rate for Payer: Cofinity Commercial	$144.77
Rate for Payer: Cofinity Medicare Advantage	$117.84
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: PHP Commercial	$143.09
Rate for Payer: Priority Health Cigna Priority Health	$109.42
Rate for Payer: Priority Health SBD	$106.05

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$5.62

Service Code	NDC 49884032152
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$2.25
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 Commercial	$3.93
Rate for Payer: Cofinity Commercial	$4.83
Rate for Payer: Cofinity Medicare Advantage	$3.93
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: PHP Commercial	$4.78
Rate for Payer: Priority Health Cigna Priority Health	$3.65
Rate for Payer: Priority Health SBD	$3.54

OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION

Facility

$53.89

Service Code	HCPCS J2359
Hospital Charge Code	38263
Hospital Revenue Code	636
Min. Negotiated Rate	$21.56
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$45.81
Rate for Payer: Aetna Commercial	$96.76
Rate for Payer: Aetna Medicare	$56.92
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)	$74.00
Rate for Payer: BCBS Complete	$21.56
Rate for Payer: BCBS Complete	$45.54
Rate for Payer: Cash Price	$43.11
Rate for Payer: Cash Price	$91.07
Rate for Payer: Cofinity Commercial	$46.35
Rate for Payer: Cofinity Commercial	$79.69
Rate for Payer: Cofinity Commercial	$97.90
Rate for Payer: Cofinity Commercial	$37.72
Rate for Payer: Cofinity Medicare Advantage	$79.69
Rate for Payer: Cofinity Medicare Advantage	$37.72
Rate for Payer: Encore Health Key Benefits Commercial	$91.07
Rate for Payer: Encore Health Key Benefits Commercial	$43.11
Rate for Payer: Healthscope Commercial	$48.50
Rate for Payer: Healthscope Commercial	$102.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.76
Rate for Payer: PHP Commercial	$45.81
Rate for Payer: PHP Commercial	$96.76
Rate for Payer: Priority Health Cigna Priority Health	$74.00
Rate for Payer: Priority Health Cigna Priority Health	$35.03
Rate for Payer: Priority Health SBD	$71.72
Rate for Payer: Priority Health SBD	$33.95

OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION

Facility

$53.89

Service Code	HCPCS J2359
Hospital Charge Code	38263
Hospital Revenue Code	636
Min. Negotiated Rate	$33.95
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial	$45.81
Rate for Payer: Aetna Commercial	$96.76
Rate for Payer: Aetna New Business (MI Preferred)	$74.00
Rate for Payer: Aetna New Business (MI Preferred)	$35.03
Rate for Payer: Cash Price	$91.07
Rate for Payer: Cash Price	$43.11
Rate for Payer: Cofinity Commercial	$46.35
Rate for Payer: Cofinity Commercial	$37.72
Rate for Payer: Cofinity Commercial	$79.69
Rate for Payer: Cofinity Commercial	$97.90
Rate for Payer: Cofinity Medicare Advantage	$79.69
Rate for Payer: Cofinity Medicare Advantage	$37.72
Rate for Payer: Encore Health Key Benefits Commercial	$91.07
Rate for Payer: Encore Health Key Benefits Commercial	$43.11
Rate for Payer: Healthscope Commercial	$48.50
Rate for Payer: Healthscope Commercial	$102.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.81
Rate for Payer: PHP Commercial	$45.81
Rate for Payer: PHP Commercial	$96.76
Rate for Payer: Priority Health Cigna Priority Health	$74.00
Rate for Payer: Priority Health Cigna Priority Health	$35.03
Rate for Payer: Priority Health SBD	$71.72
Rate for Payer: Priority Health SBD	$33.95

OLANZAPINE 10 MG TABLET

Facility

$392.45

Service Code	NDC 00904637661
Hospital Charge Code	17937
Hospital Revenue Code	637
Min. Negotiated Rate	$156.98
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 Commercial	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Cofinity Medicare Advantage	$274.71
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: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$255.09
Rate for Payer: Priority Health SBD	$247.24

OLANZAPINE 10 MG TABLET

Facility

$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 Commercial	$274.71
Rate for Payer: Cofinity Commercial	$337.51
Rate for Payer: Cofinity Medicare Advantage	$274.71
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: PHP Commercial	$333.58
Rate for Payer: Priority Health Cigna Priority Health	$255.09
Rate for Payer: Priority Health SBD	$247.24

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$68.69

Service Code	NDC 33342008307
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$61.82
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna Medicare	$34.34
Rate for Payer: Aetna New Business (MI Preferred)	$44.65
Rate for Payer: BCBS Complete	$27.48
Rate for Payer: Cash Price	$54.95
Rate for Payer: Cofinity Commercial	$48.08
Rate for Payer: Cofinity Commercial	$59.07
Rate for Payer: Cofinity Medicare Advantage	$48.08
Rate for Payer: Encore Health Key Benefits Commercial	$54.95
Rate for Payer: Healthscope Commercial	$61.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.39
Rate for Payer: PHP Commercial	$58.39
Rate for Payer: Priority Health Cigna Priority Health	$44.65
Rate for Payer: Priority Health SBD	$43.27

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$2.69
Rate for Payer: Cofinity Commercial	$3.30
Rate for Payer: Cofinity Medicare Advantage	$2.69
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: PHP Commercial	$3.26
Rate for Payer: Priority Health Cigna Priority Health	$2.50
Rate for Payer: Priority Health SBD	$2.42

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$231.56

Service Code	NDC 55111026281
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$92.62
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 Commercial	$162.09
Rate for Payer: Cofinity Commercial	$199.14
Rate for Payer: Cofinity Medicare Advantage	$162.09
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: PHP Commercial	$196.83
Rate for Payer: Priority Health Cigna Priority Health	$150.51
Rate for Payer: Priority Health SBD	$145.88

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$162.09
Rate for Payer: Cofinity Commercial	$199.14
Rate for Payer: Cofinity Medicare Advantage	$162.09
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: PHP Commercial	$196.83
Rate for Payer: Priority Health Cigna Priority Health	$150.51
Rate for Payer: Priority Health SBD	$145.88

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$7.72

Service Code	NDC 55111026279
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$3.09
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 Commercial	$5.40
Rate for Payer: Cofinity Commercial	$6.64
Rate for Payer: Cofinity Medicare Advantage	$5.40
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: PHP Commercial	$6.56
Rate for Payer: Priority Health Cigna Priority Health	$5.02
Rate for Payer: Priority Health SBD	$4.86

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$5.40
Rate for Payer: Cofinity Commercial	$6.64
Rate for Payer: Cofinity Medicare Advantage	$5.40
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: PHP Commercial	$6.56
Rate for Payer: Priority Health Cigna Priority Health	$5.02
Rate for Payer: Priority Health SBD	$4.86

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$68.69

Service Code	NDC 33342008307
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$43.27
Max. Negotiated Rate	$61.82
Rate for Payer: Aetna Commercial	$58.39
Rate for Payer: Aetna New Business (MI Preferred)	$44.65
Rate for Payer: Cash Price	$54.95
Rate for Payer: Cofinity Commercial	$48.08
Rate for Payer: Cofinity Commercial	$59.07
Rate for Payer: Cofinity Medicare Advantage	$48.08
Rate for Payer: Encore Health Key Benefits Commercial	$54.95
Rate for Payer: Healthscope Commercial	$61.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.39
Rate for Payer: PHP Commercial	$58.39
Rate for Payer: Priority Health Cigna Priority Health	$44.65
Rate for Payer: Priority Health SBD	$43.27

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$814.08

Service Code	NDC 60505327500
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$325.63
Max. Negotiated Rate	$732.67
Rate for Payer: Aetna Commercial	$691.97
Rate for Payer: Aetna Medicare	$407.04
Rate for Payer: Aetna New Business (MI Preferred)	$529.15
Rate for Payer: BCBS Complete	$325.63
Rate for Payer: Cash Price	$651.26
Rate for Payer: Cofinity Commercial	$569.86
Rate for Payer: Cofinity Commercial	$700.11
Rate for Payer: Cofinity Medicare Advantage	$569.86
Rate for Payer: Encore Health Key Benefits Commercial	$651.26
Rate for Payer: Healthscope Commercial	$732.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$691.97
Rate for Payer: PHP Commercial	$691.97
Rate for Payer: Priority Health Cigna Priority Health	$529.15
Rate for Payer: Priority Health SBD	$512.87

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$814.08

Service Code	NDC 60505327500
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$512.87
Max. Negotiated Rate	$732.67
Rate for Payer: Aetna Commercial	$691.97
Rate for Payer: Aetna New Business (MI Preferred)	$529.15
Rate for Payer: Cash Price	$651.26
Rate for Payer: Cofinity Commercial	$569.86
Rate for Payer: Cofinity Commercial	$700.11
Rate for Payer: Cofinity Medicare Advantage	$569.86
Rate for Payer: Encore Health Key Benefits Commercial	$651.26
Rate for Payer: Healthscope Commercial	$732.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$691.97
Rate for Payer: PHP Commercial	$691.97
Rate for Payer: Priority Health Cigna Priority Health	$529.15
Rate for Payer: Priority Health SBD	$512.87

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$115.20

Service Code	NDC 59746030632
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$46.08
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 Commercial	$80.64
Rate for Payer: Cofinity Commercial	$99.07
Rate for Payer: Cofinity Medicare Advantage	$80.64
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: PHP Commercial	$97.92
Rate for Payer: Priority Health Cigna Priority Health	$74.88
Rate for Payer: Priority Health SBD	$72.58

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$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 Commercial	$80.64
Rate for Payer: Cofinity Commercial	$99.07
Rate for Payer: Cofinity Medicare Advantage	$80.64
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: PHP Commercial	$97.92
Rate for Payer: Priority Health Cigna Priority Health	$74.88
Rate for Payer: Priority Health SBD	$72.58

Know your out-of-pocket cost for care.

All Charges