Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$3.84

Service Code	NDC 59746030612
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
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 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 TABLET

Facility

$3.30

Service Code	NDC 68084072311
Hospital Charge Code	17936
Hospital Revenue Code	637
Min. Negotiated Rate	$1.32
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 Commercial	$2.31
Rate for Payer: Cofinity Commercial	$2.84
Rate for Payer: Cofinity Medicare Advantage	$2.31
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: PHP Commercial	$2.81
Rate for Payer: Priority Health Cigna Priority Health	$2.15
Rate for Payer: Priority Health SBD	$2.08

OLANZAPINE 5 MG TABLET

Facility

$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 Commercial	$2.31
Rate for Payer: Cofinity Commercial	$2.84
Rate for Payer: Cofinity Medicare Advantage	$2.31
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: PHP Commercial	$2.81
Rate for Payer: Priority Health Cigna Priority Health	$2.15
Rate for Payer: Priority Health SBD	$2.08

OLANZAPINE 5 MG TABLET

Facility

$265.55

Service Code	NDC 00904637761
Hospital Charge Code	17936
Hospital Revenue Code	637
Min. Negotiated Rate	$106.22
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna Medicare	$132.78
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: BCBS Complete	$106.22
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Commercial	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Cofinity Medicare Advantage	$185.88
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health Cigna Priority Health	$172.61
Rate for Payer: Priority Health SBD	$167.30

OLANZAPINE 5 MG TABLET

Facility

$265.55

Service Code	NDC 00904637761
Hospital Charge Code	17936
Hospital Revenue Code	637
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Commercial	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Cofinity Medicare Advantage	$185.88
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health Cigna Priority Health	$172.61
Rate for Payer: Priority Health SBD	$167.30

OLOPATADINE 0.1 % EYE DROPS

Facility

$43.23

Service Code	NDC 00536130840
Hospital Charge Code	19452
Hospital Revenue Code	637
Min. Negotiated Rate	$17.29
Max. Negotiated Rate	$38.91
Rate for Payer: Aetna Commercial	$36.75
Rate for Payer: Aetna Medicare	$21.61
Rate for Payer: Aetna New Business (MI Preferred)	$28.10
Rate for Payer: BCBS Complete	$17.29
Rate for Payer: Cash Price	$34.58
Rate for Payer: Cofinity Commercial	$30.26
Rate for Payer: Cofinity Commercial	$37.18
Rate for Payer: Cofinity Medicare Advantage	$30.26
Rate for Payer: Encore Health Key Benefits Commercial	$34.58
Rate for Payer: Healthscope Commercial	$38.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.75
Rate for Payer: PHP Commercial	$36.75
Rate for Payer: Priority Health Cigna Priority Health	$28.10
Rate for Payer: Priority Health SBD	$27.23

OLOPATADINE 0.1 % EYE DROPS

Facility

$43.23

Service Code	NDC 00536130840
Hospital Charge Code	19452
Hospital Revenue Code	637
Min. Negotiated Rate	$27.23
Max. Negotiated Rate	$38.91
Rate for Payer: Aetna Commercial	$36.75
Rate for Payer: Aetna New Business (MI Preferred)	$28.10
Rate for Payer: Cash Price	$34.58
Rate for Payer: Cofinity Commercial	$30.26
Rate for Payer: Cofinity Commercial	$37.18
Rate for Payer: Cofinity Medicare Advantage	$30.26
Rate for Payer: Encore Health Key Benefits Commercial	$34.58
Rate for Payer: Healthscope Commercial	$38.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$36.75
Rate for Payer: PHP Commercial	$36.75
Rate for Payer: Priority Health Cigna Priority Health	$28.10
Rate for Payer: Priority Health SBD	$27.23

OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE

Facility

$4,531.59

Service Code	HCPCS J2357
Hospital Charge Code	188928
Hospital Revenue Code	636
Min. Negotiated Rate	$23.91
Max. Negotiated Rate	$4,078.43
Rate for Payer: Aetna Commercial	$3,851.85
Rate for Payer: Aetna Medicare	$46.38
Rate for Payer: Aetna New Business (MI Preferred)	$2,945.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$55.75
Rate for Payer: Amish Plain Church Group Commercial	$55.75
Rate for Payer: BCBS Complete	$25.10
Rate for Payer: BCBS MAPPO	$44.60
Rate for Payer: BCN Medicare Advantage	$44.60
Rate for Payer: Cash Price	$3,625.27
Rate for Payer: Cash Price	$3,625.27
Rate for Payer: Cofinity Commercial	$3,897.17
Rate for Payer: Cofinity Commercial	$3,172.11
Rate for Payer: Cofinity Medicare Advantage	$3,172.11
Rate for Payer: Encore Health Key Benefits Commercial	$3,625.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$44.60
Rate for Payer: Healthscope Commercial	$4,078.43
Rate for Payer: Mclaren Medicaid	$23.91
Rate for Payer: Mclaren Medicare	$44.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$46.83
Rate for Payer: Meridian Medicaid	$25.10
Rate for Payer: MI Amish Medical Board Commercial	$51.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,851.85
Rate for Payer: PACE Medicare	$42.37
Rate for Payer: PACE SWMI	$44.60
Rate for Payer: PHP Commercial	$3,851.85
Rate for Payer: PHP Medicare Advantage	$44.60
Rate for Payer: Priority Health Choice Medicaid	$23.91
Rate for Payer: Priority Health Cigna Priority Health	$2,945.53
Rate for Payer: Priority Health Medicare	$44.60
Rate for Payer: Priority Health SBD	$2,854.90
Rate for Payer: Railroad Medicare Medicare	$44.60
Rate for Payer: UHC All Payor (Choice/PPO)	$125.54
Rate for Payer: UHC Dual Complete DSNP	$44.60
Rate for Payer: UHC Medicare Advantage	$44.60
Rate for Payer: UHCCP Medicaid	$25.11
Rate for Payer: VA VA	$44.60

OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE

Facility

$4,531.59

Service Code	HCPCS J2357
Hospital Charge Code	188928
Hospital Revenue Code	636
Min. Negotiated Rate	$2,854.90
Max. Negotiated Rate	$4,078.43
Rate for Payer: Aetna Commercial	$3,851.85
Rate for Payer: Aetna New Business (MI Preferred)	$2,945.53
Rate for Payer: Cash Price	$3,625.27
Rate for Payer: Cofinity Commercial	$3,172.11
Rate for Payer: Cofinity Commercial	$3,897.17
Rate for Payer: Cofinity Medicare Advantage	$3,172.11
Rate for Payer: Encore Health Key Benefits Commercial	$3,625.27
Rate for Payer: Healthscope Commercial	$4,078.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,851.85
Rate for Payer: PHP Commercial	$3,851.85
Rate for Payer: Priority Health Cigna Priority Health	$2,945.53
Rate for Payer: Priority Health SBD	$2,854.90

OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$2,265.80

Service Code	HCPCS J2357
Hospital Charge Code	188926
Hospital Revenue Code	636
Min. Negotiated Rate	$23.91
Max. Negotiated Rate	$2,039.22
Rate for Payer: Aetna Commercial	$1,925.93
Rate for Payer: Aetna Medicare	$46.38
Rate for Payer: Aetna New Business (MI Preferred)	$1,472.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$55.75
Rate for Payer: Amish Plain Church Group Commercial	$55.75
Rate for Payer: BCBS Complete	$25.10
Rate for Payer: BCBS MAPPO	$44.60
Rate for Payer: BCN Medicare Advantage	$44.60
Rate for Payer: Cash Price	$1,812.64
Rate for Payer: Cash Price	$1,812.64
Rate for Payer: Cofinity Commercial	$1,948.59
Rate for Payer: Cofinity Commercial	$1,586.06
Rate for Payer: Cofinity Medicare Advantage	$1,586.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,812.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$44.60
Rate for Payer: Healthscope Commercial	$2,039.22
Rate for Payer: Mclaren Medicaid	$23.91
Rate for Payer: Mclaren Medicare	$44.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$46.83
Rate for Payer: Meridian Medicaid	$25.10
Rate for Payer: MI Amish Medical Board Commercial	$51.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,925.93
Rate for Payer: PACE Medicare	$42.37
Rate for Payer: PACE SWMI	$44.60
Rate for Payer: PHP Commercial	$1,925.93
Rate for Payer: PHP Medicare Advantage	$44.60
Rate for Payer: Priority Health Choice Medicaid	$23.91
Rate for Payer: Priority Health Cigna Priority Health	$1,472.77
Rate for Payer: Priority Health Medicare	$44.60
Rate for Payer: Priority Health SBD	$1,427.45
Rate for Payer: Railroad Medicare Medicare	$44.60
Rate for Payer: UHC All Payor (Choice/PPO)	$125.54
Rate for Payer: UHC Dual Complete DSNP	$44.60
Rate for Payer: UHC Medicare Advantage	$44.60
Rate for Payer: UHCCP Medicaid	$25.11
Rate for Payer: VA VA	$44.60

OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$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 Commercial	$1,586.06
Rate for Payer: Cofinity Commercial	$1,948.59
Rate for Payer: Cofinity Medicare Advantage	$1,586.06
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: PHP Commercial	$1,925.93
Rate for Payer: Priority Health Cigna Priority Health	$1,472.77
Rate for Payer: Priority Health SBD	$1,427.45

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$434.88

Service Code	NDC 60505317007
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$273.97
Max. Negotiated Rate	$391.39
Rate for Payer: Aetna Commercial	$369.65
Rate for Payer: Aetna New Business (MI Preferred)	$282.67
Rate for Payer: Cash Price	$347.90
Rate for Payer: Cofinity Commercial	$304.42
Rate for Payer: Cofinity Commercial	$374.00
Rate for Payer: Cofinity Medicare Advantage	$304.42
Rate for Payer: Encore Health Key Benefits Commercial	$347.90
Rate for Payer: Healthscope Commercial	$391.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.65
Rate for Payer: PHP Commercial	$369.65
Rate for Payer: Priority Health Cigna Priority Health	$282.67
Rate for Payer: Priority Health SBD	$273.97

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$485.07

Service Code	NDC 60687012765
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$194.03
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 Commercial	$339.55
Rate for Payer: Cofinity Commercial	$417.16
Rate for Payer: Cofinity Medicare Advantage	$339.55
Rate for Payer: Encore Health Key Benefits Commercial	$388.06
Rate for Payer: Healthscope Commercial	$436.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$412.31
Rate for Payer: PHP Commercial	$412.31
Rate for Payer: Priority Health Cigna Priority Health	$315.30
Rate for Payer: Priority Health SBD	$305.59

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$9.71

Service Code	NDC 60687012711
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$3.88
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 Commercial	$6.80
Rate for Payer: Cofinity Commercial	$8.35
Rate for Payer: Cofinity Medicare Advantage	$6.80
Rate for Payer: Encore Health Key Benefits Commercial	$7.77
Rate for Payer: Healthscope Commercial	$8.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.25
Rate for Payer: PHP Commercial	$8.25
Rate for Payer: Priority Health Cigna Priority Health	$6.31
Rate for Payer: Priority Health SBD	$6.12

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$434.88

Service Code	NDC 60505317007
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$173.95
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 Commercial	$304.42
Rate for Payer: Cofinity Commercial	$374.00
Rate for Payer: Cofinity Medicare Advantage	$304.42
Rate for Payer: Encore Health Key Benefits Commercial	$347.90
Rate for Payer: Healthscope Commercial	$391.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.65
Rate for Payer: PHP Commercial	$369.65
Rate for Payer: Priority Health Cigna Priority Health	$282.67
Rate for Payer: Priority Health SBD	$273.97

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$238.26

Service Code	NDC 64380076111
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$95.30
Max. Negotiated Rate	$214.43
Rate for Payer: Aetna Commercial	$202.52
Rate for Payer: Aetna Medicare	$119.13
Rate for Payer: Aetna New Business (MI Preferred)	$154.87
Rate for Payer: BCBS Complete	$95.30
Rate for Payer: Cash Price	$190.61
Rate for Payer: Cofinity Commercial	$166.78
Rate for Payer: Cofinity Commercial	$204.90
Rate for Payer: Cofinity Medicare Advantage	$166.78
Rate for Payer: Encore Health Key Benefits Commercial	$190.61
Rate for Payer: Healthscope Commercial	$214.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.52
Rate for Payer: PHP Commercial	$202.52
Rate for Payer: Priority Health Cigna Priority Health	$154.87
Rate for Payer: Priority Health SBD	$150.10

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$238.26

Service Code	NDC 64380076111
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$150.10
Max. Negotiated Rate	$214.43
Rate for Payer: Aetna Commercial	$202.52
Rate for Payer: Aetna New Business (MI Preferred)	$154.87
Rate for Payer: Cash Price	$190.61
Rate for Payer: Cofinity Commercial	$166.78
Rate for Payer: Cofinity Commercial	$204.90
Rate for Payer: Cofinity Medicare Advantage	$166.78
Rate for Payer: Encore Health Key Benefits Commercial	$190.61
Rate for Payer: Healthscope Commercial	$214.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.52
Rate for Payer: PHP Commercial	$202.52
Rate for Payer: Priority Health Cigna Priority Health	$154.87
Rate for Payer: Priority Health SBD	$150.10

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$440.86

Service Code	NDC 00904670606
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$277.74
Max. Negotiated Rate	$396.77
Rate for Payer: Aetna Commercial	$374.73
Rate for Payer: Aetna New Business (MI Preferred)	$286.56
Rate for Payer: Cash Price	$352.69
Rate for Payer: Cofinity Commercial	$308.60
Rate for Payer: Cofinity Commercial	$379.14
Rate for Payer: Cofinity Medicare Advantage	$308.60
Rate for Payer: Encore Health Key Benefits Commercial	$352.69
Rate for Payer: Healthscope Commercial	$396.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.73
Rate for Payer: PHP Commercial	$374.73
Rate for Payer: Priority Health Cigna Priority Health	$286.56
Rate for Payer: Priority Health SBD	$277.74

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$440.86

Service Code	NDC 00904670606
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$176.34
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 Commercial	$308.60
Rate for Payer: Cofinity Commercial	$379.14
Rate for Payer: Cofinity Medicare Advantage	$308.60
Rate for Payer: Encore Health Key Benefits Commercial	$352.69
Rate for Payer: Healthscope Commercial	$396.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.73
Rate for Payer: PHP Commercial	$374.73
Rate for Payer: Priority Health Cigna Priority Health	$286.56
Rate for Payer: Priority Health SBD	$277.74

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION

Facility

$2,067.20

Service Code	HCPCS J0585
Hospital Charge Code	32700
Hospital Revenue Code	636
Min. Negotiated Rate	$1,302.34
Max. Negotiated Rate	$1,860.48
Rate for Payer: Aetna Commercial	$1,757.12
Rate for Payer: Aetna New Business (MI Preferred)	$1,343.68
Rate for Payer: Cash Price	$1,653.76
Rate for Payer: Cofinity Commercial	$1,447.04
Rate for Payer: Cofinity Commercial	$1,777.79
Rate for Payer: Cofinity Medicare Advantage	$1,447.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,653.76
Rate for Payer: Healthscope Commercial	$1,860.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,757.12
Rate for Payer: PHP Commercial	$1,757.12
Rate for Payer: Priority Health Cigna Priority Health	$1,343.68
Rate for Payer: Priority Health SBD	$1,302.34

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION

Facility

$2,067.20

Service Code	HCPCS J0585
Hospital Charge Code	32700
Hospital Revenue Code	636
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$1,860.48
Rate for Payer: Aetna Commercial	$1,757.12
Rate for Payer: Aetna Medicare	$6.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,343.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$8.12
Rate for Payer: Amish Plain Church Group Commercial	$8.12
Rate for Payer: BCBS Complete	$3.66
Rate for Payer: BCBS MAPPO	$6.50
Rate for Payer: BCN Medicare Advantage	$6.50
Rate for Payer: Cash Price	$1,653.76
Rate for Payer: Cash Price	$1,653.76
Rate for Payer: Cofinity Commercial	$1,447.04
Rate for Payer: Cofinity Commercial	$1,777.79
Rate for Payer: Cofinity Medicare Advantage	$1,447.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,653.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.50
Rate for Payer: Healthscope Commercial	$1,860.48
Rate for Payer: Mclaren Medicaid	$3.48
Rate for Payer: Mclaren Medicare	$6.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6.83
Rate for Payer: Meridian Medicaid	$3.66
Rate for Payer: MI Amish Medical Board Commercial	$7.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,757.12
Rate for Payer: PACE Medicare	$6.17
Rate for Payer: PACE SWMI	$6.50
Rate for Payer: PHP Commercial	$1,757.12
Rate for Payer: PHP Medicare Advantage	$6.50
Rate for Payer: Priority Health Choice Medicaid	$3.48
Rate for Payer: Priority Health Cigna Priority Health	$1,343.68
Rate for Payer: Priority Health Medicare	$6.50
Rate for Payer: Priority Health SBD	$1,302.34
Rate for Payer: Railroad Medicare Medicare	$6.50
Rate for Payer: UHC All Payor (Choice/PPO)	$18.30
Rate for Payer: UHC Dual Complete DSNP	$6.50
Rate for Payer: UHC Medicare Advantage	$6.50
Rate for Payer: UHCCP Medicaid	$3.66
Rate for Payer: VA VA	$6.50

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$69.26

Service Code	NDC 57237007730
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$43.63
Max. Negotiated Rate	$62.33
Rate for Payer: Aetna Commercial	$58.87
Rate for Payer: Aetna New Business (MI Preferred)	$45.02
Rate for Payer: Cash Price	$55.41
Rate for Payer: Cofinity Commercial	$48.48
Rate for Payer: Cofinity Commercial	$59.56
Rate for Payer: Cofinity Medicare Advantage	$48.48
Rate for Payer: Encore Health Key Benefits Commercial	$55.41
Rate for Payer: Healthscope Commercial	$62.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.87
Rate for Payer: PHP Commercial	$58.87
Rate for Payer: Priority Health Cigna Priority Health	$45.02
Rate for Payer: Priority Health SBD	$43.63

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$137.48

Service Code	NDC 68462015713
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$86.61
Max. Negotiated Rate	$123.73
Rate for Payer: Aetna Commercial	$116.86
Rate for Payer: Aetna New Business (MI Preferred)	$89.36
Rate for Payer: Cash Price	$109.98
Rate for Payer: Cofinity Commercial	$118.23
Rate for Payer: Cofinity Commercial	$96.24
Rate for Payer: Cofinity Medicare Advantage	$96.24
Rate for Payer: Encore Health Key Benefits Commercial	$109.98
Rate for Payer: Healthscope Commercial	$123.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$116.86
Rate for Payer: PHP Commercial	$116.86
Rate for Payer: Priority Health Cigna Priority Health	$89.36
Rate for Payer: Priority Health SBD	$86.61

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$81.94

Service Code	NDC 00378773293
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$32.78
Max. Negotiated Rate	$73.75
Rate for Payer: Aetna Commercial	$69.65
Rate for Payer: Aetna Medicare	$40.97
Rate for Payer: Aetna New Business (MI Preferred)	$53.26
Rate for Payer: BCBS Complete	$32.78
Rate for Payer: Cash Price	$65.55
Rate for Payer: Cofinity Commercial	$57.36
Rate for Payer: Cofinity Commercial	$70.47
Rate for Payer: Cofinity Medicare Advantage	$57.36
Rate for Payer: Encore Health Key Benefits Commercial	$65.55
Rate for Payer: Healthscope Commercial	$73.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.65
Rate for Payer: PHP Commercial	$69.65
Rate for Payer: Priority Health Cigna Priority Health	$53.26
Rate for Payer: Priority Health SBD	$51.62

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$69.26

Service Code	NDC 57237007730
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$62.33
Rate for Payer: Aetna Commercial	$58.87
Rate for Payer: Aetna Medicare	$34.63
Rate for Payer: Aetna New Business (MI Preferred)	$45.02
Rate for Payer: BCBS Complete	$27.70
Rate for Payer: Cash Price	$55.41
Rate for Payer: Cofinity Commercial	$48.48
Rate for Payer: Cofinity Commercial	$59.56
Rate for Payer: Cofinity Medicare Advantage	$48.48
Rate for Payer: Encore Health Key Benefits Commercial	$55.41
Rate for Payer: Healthscope Commercial	$62.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.87
Rate for Payer: PHP Commercial	$58.87
Rate for Payer: Priority Health Cigna Priority Health	$45.02
Rate for Payer: Priority Health SBD	$43.63

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