|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$21.81
|
|
|
Service Code
|
NDC 61314-271-05
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$19.63 |
| Rate for Payer: Aetna Commercial |
$18.54
|
| Rate for Payer: BCBS Trust/PPO |
$16.85
|
| Rate for Payer: BCN Commercial |
$16.85
|
| Rate for Payer: Cash Price |
$17.45
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.45
|
| Rate for Payer: Healthscope Commercial |
$19.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.54
|
| Rate for Payer: PHP Commercial |
$18.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.19
|
| Rate for Payer: UHC Core |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.36
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$31.33
|
|
|
Service Code
|
NDC 43598-765-07
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: BCBS Trust/PPO |
$24.21
|
| Rate for Payer: BCN Commercial |
$24.21
|
| Rate for Payer: Cash Price |
$25.06
|
| Rate for Payer: Cofinity Commercial |
$26.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$28.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.63
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.57
|
| Rate for Payer: UHC Core |
$26.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$47.64
|
|
|
Service Code
|
NDC 0536-1308-40
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$42.88 |
| Rate for Payer: Aetna Commercial |
$40.49
|
| Rate for Payer: BCBS Trust/PPO |
$36.82
|
| Rate for Payer: BCN Commercial |
$36.82
|
| Rate for Payer: Cash Price |
$38.11
|
| Rate for Payer: Cofinity Commercial |
$40.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.11
|
| Rate for Payer: Healthscope Commercial |
$42.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.49
|
| Rate for Payer: PHP Commercial |
$40.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.92
|
| Rate for Payer: UHC Core |
$39.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.73
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$493.50
|
|
|
Service Code
|
NDC 60505-3170-7
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.99 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna Commercial |
$419.48
|
| Rate for Payer: BCBS Trust/PPO |
$381.38
|
| Rate for Payer: BCN Commercial |
$381.38
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cofinity Commercial |
$424.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.80
|
| Rate for Payer: Healthscope Commercial |
$444.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.48
|
| Rate for Payer: PHP Commercial |
$419.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.28
|
| Rate for Payer: UHC Core |
$412.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.12
|
|
|
OMEGA-3 FATTY ACIDS-FISH OIL 300 MG-1,000 MG CAPSULE
|
Facility
|
IP
|
$196.70
|
|
|
Service Code
|
NDC 4098522731
|
| Hospital Charge Code |
10774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$177.03 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: BCBS Trust/PPO |
$152.01
|
| Rate for Payer: BCN Commercial |
$152.01
|
| Rate for Payer: Cash Price |
$157.36
|
| Rate for Payer: Cofinity Commercial |
$169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.36
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.20
|
| Rate for Payer: PHP Commercial |
$167.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.10
|
| Rate for Payer: UHC Core |
$164.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.52
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,028.80
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,237.37 |
| Max. Negotiated Rate |
$1,825.92 |
| Rate for Payer: Aetna Commercial |
$1,724.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,567.86
|
| Rate for Payer: BCN Commercial |
$1,567.86
|
| Rate for Payer: Cash Price |
$1,623.04
|
| Rate for Payer: Cofinity Commercial |
$1,744.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,623.04
|
| Rate for Payer: Healthscope Commercial |
$1,825.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,521.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,724.48
|
| Rate for Payer: PHP Commercial |
$1,724.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,420.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,765.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,237.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,785.34
|
| Rate for Payer: UHC Core |
$1,694.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,521.60
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68462-157-40
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.84
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.98
|
| Rate for Payer: UHC Core |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.39
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$127.61
|
|
|
Service Code
|
NDC 16714-200-30
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.83 |
| Max. Negotiated Rate |
$114.85 |
| Rate for Payer: Aetna Commercial |
$108.47
|
| Rate for Payer: BCBS Trust/PPO |
$98.62
|
| Rate for Payer: BCN Commercial |
$98.62
|
| Rate for Payer: Cash Price |
$102.09
|
| Rate for Payer: Cofinity Commercial |
$109.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.09
|
| Rate for Payer: Healthscope Commercial |
$114.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.47
|
| Rate for Payer: PHP Commercial |
$108.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.30
|
| Rate for Payer: UHC Core |
$106.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.71
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 0781-5238-06
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.43
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
NDC 57237-077-10
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: BCBS Trust/PPO |
$51.32
|
| Rate for Payer: BCN Commercial |
$51.32
|
| Rate for Payer: Cash Price |
$53.13
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.13
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$56.45
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.44
|
| Rate for Payer: UHC Core |
$55.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.81
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 16714-200-10
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.29
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.62
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
NDC 0781-5238-64
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: BCBS Trust/PPO |
$66.21
|
| Rate for Payer: BCN Commercial |
$66.21
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$72.83
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.40
|
| Rate for Payer: UHC Core |
$71.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.26
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$135.36
|
|
|
Service Code
|
NDC 68462-157-13
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$121.82 |
| Rate for Payer: Aetna Commercial |
$115.06
|
| Rate for Payer: BCBS Trust/PPO |
$104.61
|
| Rate for Payer: BCN Commercial |
$104.61
|
| Rate for Payer: Cash Price |
$108.29
|
| Rate for Payer: Cofinity Commercial |
$116.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.29
|
| Rate for Payer: Healthscope Commercial |
$121.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.06
|
| Rate for Payer: PHP Commercial |
$115.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.12
|
| Rate for Payer: UHC Core |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.52
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$43.74
|
|
|
Service Code
|
NDC 68094-763-62
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: BCBS Trust/PPO |
$33.80
|
| Rate for Payer: BCN Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.99
|
| Rate for Payer: Healthscope Commercial |
$39.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.18
|
| Rate for Payer: PHP Commercial |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.49
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.80
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 60687-252-86
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: BCN Commercial |
$29.85
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.84
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.99
|
| Rate for Payer: UHC Core |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$43.74
|
|
|
Service Code
|
NDC 68094-763-59
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.68 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: Aetna Commercial |
$37.18
|
| Rate for Payer: BCBS Trust/PPO |
$33.80
|
| Rate for Payer: BCN Commercial |
$33.80
|
| Rate for Payer: Cash Price |
$34.99
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.99
|
| Rate for Payer: Healthscope Commercial |
$39.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.18
|
| Rate for Payer: PHP Commercial |
$37.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.49
|
| Rate for Payer: UHC Core |
$36.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.80
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 65162-691-79
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: BCBS Trust/PPO |
$86.63
|
| Rate for Payer: BCN Commercial |
$86.63
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.65
|
| Rate for Payer: UHC Core |
$93.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.30
|
|
|
Service Code
|
NDC 9900-0003-46
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$11.05
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.58
|
| Rate for Payer: UHC Core |
$11.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
NDC 0904-7073-41
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$42.97 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: BCBS Trust/PPO |
$36.89
|
| Rate for Payer: BCN Commercial |
$36.89
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.19
|
| Rate for Payer: Healthscope Commercial |
$42.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.58
|
| Rate for Payer: PHP Commercial |
$40.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.01
|
| Rate for Payer: UHC Core |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.80
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.74
|
|
|
Service Code
|
NDC 0904-7073-93
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$42.97 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: BCBS Trust/PPO |
$36.89
|
| Rate for Payer: BCN Commercial |
$36.89
|
| Rate for Payer: Cash Price |
$38.19
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.19
|
| Rate for Payer: Healthscope Commercial |
$42.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.58
|
| Rate for Payer: PHP Commercial |
$40.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.01
|
| Rate for Payer: UHC Core |
$39.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.80
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 60687-252-40
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: BCN Commercial |
$29.85
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.84
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.99
|
| Rate for Payer: UHC Core |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$38.63
|
|
|
Service Code
|
NDC 60687-252-46
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: BCBS Trust/PPO |
$29.85
|
| Rate for Payer: BCN Commercial |
$29.85
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cofinity Commercial |
$33.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.90
|
| Rate for Payer: Healthscope Commercial |
$34.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.84
|
| Rate for Payer: PHP Commercial |
$32.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.99
|
| Rate for Payer: UHC Core |
$32.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.97
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$165.30
|
|
|
Service Code
|
NDC 50268-621-15
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$148.77 |
| Rate for Payer: Aetna Commercial |
$140.50
|
| Rate for Payer: BCBS Trust/PPO |
$127.74
|
| Rate for Payer: BCN Commercial |
$127.74
|
| Rate for Payer: Cash Price |
$132.24
|
| Rate for Payer: Cofinity Commercial |
$142.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.24
|
| Rate for Payer: Healthscope Commercial |
$148.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.50
|
| Rate for Payer: PHP Commercial |
$140.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.46
|
| Rate for Payer: UHC Core |
$138.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.98
|
|
|
ONDANSETRON HCL 4 MG TABLET
|
Facility
|
IP
|
$3.31
|
|
|
Service Code
|
NDC 50268-621-11
|
| Hospital Charge Code |
10778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$2.65
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.65
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.91
|
| Rate for Payer: UHC Core |
$2.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$10.33
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$7.03
|
| Rate for Payer: BCN Commercial |
$7.03
|
| Rate for Payer: BCN Commercial |
$13.36
|
| Rate for Payer: BCN Commercial |
$9.39
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$10.45
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$10.94
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.74
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: PHP Commercial |
$10.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.69
|
| Rate for Payer: UHC Core |
$7.60
|
| Rate for Payer: UHC Core |
$10.15
|
| Rate for Payer: UHC Core |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.82
|
|
