|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.89 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: BCBS Trust/PPO |
$277.54
|
| Rate for Payer: BCN Commercial |
$277.54
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$79.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.47
|
| Rate for Payer: BCBS Complete |
$56.55
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$251.15
|
| Rate for Payer: BCN Medicare Advantage |
$76.38
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Mclaren Medicaid |
$53.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: Meridian Medicaid |
$56.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PACE Senior Care Partners |
$72.56
|
| Rate for Payer: PACE SWMI |
$76.38
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: PHP Medicare Advantage |
$76.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.63
|
| Rate for Payer: Railroad Medicare Medicare |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicaid |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| Rate for Payer: UHCCP Medicaid |
$53.86
|
| Rate for Payer: VA VA |
$76.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.63 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$252.31
|
| Rate for Payer: BCN Commercial |
$252.31
|
| Rate for Payer: Cash Price |
$244.40
|
| 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: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.25 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$87.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.02
|
| Rate for Payer: BCBS Complete |
$62.20
|
| Rate for Payer: BCBS MAPPO |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$276.27
|
| Rate for Payer: BCN Commercial |
$276.27
|
| Rate for Payer: BCN Medicare Advantage |
$84.01
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.01
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Mclaren Medicaid |
$59.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.21
|
| Rate for Payer: Meridian Medicaid |
$62.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PACE Senior Care Partners |
$79.81
|
| Rate for Payer: PACE SWMI |
$84.01
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Medicare |
$84.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$233.89
|
| Rate for Payer: Railroad Medicare Medicare |
$84.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: UHC Exchange |
$84.01
|
| Rate for Payer: UHC Medicaid |
$59.25
|
| Rate for Payer: UHC Medicare Advantage |
$84.01
|
| Rate for Payer: UHCCP Medicaid |
$59.25
|
| Rate for Payer: VA VA |
$84.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$20.57
|
|
|
Service Code
|
NDC 00536130840
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Medicare |
$5.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.43
|
| Rate for Payer: BCBS Complete |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.91
|
| Rate for Payer: BCN Commercial |
$16.91
|
| Rate for Payer: BCN Medicare Advantage |
$5.14
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$18.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Mclaren Medicaid |
$3.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.40
|
| Rate for Payer: Meridian Medicaid |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Nomi Health Commercial |
$16.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.43
|
| Rate for Payer: PACE Senior Care Partners |
$4.89
|
| Rate for Payer: PACE SWMI |
$5.14
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Medicare Advantage |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.10
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Exchange |
$5.14
|
| Rate for Payer: UHC Medicaid |
$3.63
|
| Rate for Payer: UHC Medicare Advantage |
$5.14
|
| Rate for Payer: UHCCP Medicaid |
$3.63
|
| Rate for Payer: VA VA |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$31.33
|
|
|
Service Code
|
NDC 43598076507
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: BCBS Trust/PPO |
$25.88
|
| Rate for Payer: BCN Commercial |
$25.88
|
| 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 Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$25.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.50
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.81
|
| 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
|
$20.57
|
|
|
Service Code
|
NDC 00536130840
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.46
|
| 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: Lakeland Regional Health Systems Commercial |
$15.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Nomi Health Commercial |
$16.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.43
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.10
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.43
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$31.33
|
|
|
Service Code
|
NDC 43598076507
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.79
|
| Rate for Payer: BCBS Complete |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$25.76
|
| Rate for Payer: BCN Commercial |
$25.76
|
| Rate for Payer: BCN Medicare Advantage |
$7.83
|
| 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: Health Alliance Plan Medicare Advantage |
$7.83
|
| Rate for Payer: Healthscope Commercial |
$28.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.50
|
| Rate for Payer: Mclaren Medicaid |
$5.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.22
|
| Rate for Payer: Meridian Medicaid |
$5.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$25.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.50
|
| Rate for Payer: PACE Senior Care Partners |
$7.44
|
| Rate for Payer: PACE SWMI |
$7.83
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: PHP Medicare Advantage |
$7.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.26
|
| Rate for Payer: Priority Health Medicare |
$7.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.57
|
| Rate for Payer: UHC Core |
$26.16
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicaid |
$5.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.83
|
| Rate for Payer: UHCCP Medicaid |
$5.52
|
| Rate for Payer: VA VA |
$7.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
|
|
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 |
$87.34 |
| Max. Negotiated Rate |
$445.89 |
| Rate for Payer: Aetna Commercial |
$421.12
|
| Rate for Payer: Aetna Medicare |
$128.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.82
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$123.86
|
| Rate for Payer: BCBS Trust/PPO |
$407.29
|
| Rate for Payer: BCN Commercial |
$407.29
|
| Rate for Payer: BCN Medicare Advantage |
$123.86
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Cofinity Commercial |
$426.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.86
|
| Rate for Payer: Healthscope Commercial |
$445.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$371.57
|
| Rate for Payer: Mclaren Medicaid |
$87.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.05
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.12
|
| Rate for Payer: Nomi Health Commercial |
$406.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.57
|
| Rate for Payer: PACE Senior Care Partners |
$117.66
|
| Rate for Payer: PACE SWMI |
$123.86
|
| Rate for Payer: PHP Commercial |
$421.12
|
| Rate for Payer: PHP Medicare Advantage |
$123.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.02
|
| Rate for Payer: Priority Health Medicare |
$125.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.82
|
| Rate for Payer: Railroad Medicare Medicare |
$123.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.98
|
| Rate for Payer: UHC Core |
$413.68
|
| Rate for Payer: UHC Exchange |
$123.86
|
| Rate for Payer: UHC Medicaid |
$87.34
|
| Rate for Payer: UHC Medicare Advantage |
$123.86
|
| Rate for Payer: UHCCP Medicaid |
$87.34
|
| Rate for Payer: VA VA |
$123.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.57
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$495.43
|
|
|
Service Code
|
NDC 00904749506
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.82 |
| Max. Negotiated Rate |
$445.89 |
| Rate for Payer: Aetna Commercial |
$421.12
|
| Rate for Payer: BCBS Trust/PPO |
$409.18
|
| Rate for Payer: BCN Commercial |
$409.18
|
| Rate for Payer: Cash Price |
$396.34
|
| 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: Lakeland Regional Health Systems Commercial |
$371.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.12
|
| Rate for Payer: Nomi Health Commercial |
$406.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.57
|
| Rate for Payer: PHP Commercial |
$421.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$431.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.98
|
| Rate for Payer: UHC Core |
$413.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$371.57
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$434.88
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$302.68 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: BCBS Trust/PPO |
$359.17
|
| Rate for Payer: BCN Commercial |
$359.17
|
| Rate for Payer: Cash Price |
$347.90
|
| 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: Lakeland Regional Health Systems Commercial |
$326.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: Nomi Health Commercial |
$356.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.16
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$378.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.69
|
| Rate for Payer: UHC Core |
$363.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.16
|
|
|
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 |
$76.67 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: Aetna Medicare |
$113.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$135.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$135.90
|
| Rate for Payer: BCBS Complete |
$80.50
|
| Rate for Payer: BCBS MAPPO |
$108.72
|
| Rate for Payer: BCBS Trust/PPO |
$357.51
|
| Rate for Payer: BCN Commercial |
$357.51
|
| Rate for Payer: BCN Medicare Advantage |
$108.72
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cofinity Commercial |
$374.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.72
|
| Rate for Payer: Healthscope Commercial |
$391.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.16
|
| Rate for Payer: Mclaren Medicaid |
$76.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.16
|
| Rate for Payer: Meridian Medicaid |
$80.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: Nomi Health Commercial |
$356.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.16
|
| Rate for Payer: PACE Senior Care Partners |
$103.28
|
| Rate for Payer: PACE SWMI |
$108.72
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: PHP Medicare Advantage |
$108.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$378.35
|
| Rate for Payer: Priority Health Medicare |
$109.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$302.68
|
| Rate for Payer: Railroad Medicare Medicare |
$108.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.69
|
| Rate for Payer: UHC Core |
$363.12
|
| Rate for Payer: UHC Exchange |
$108.72
|
| Rate for Payer: UHC Medicaid |
$76.67
|
| Rate for Payer: UHC Medicare Advantage |
$108.72
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: VA VA |
$108.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.16
|
|
|
OMEGA-3 FATTY ACIDS-FISH OIL 300 MG-1,000 MG CAPSULE
|
Facility
|
OP
|
$213.62
|
|
|
Service Code
|
NDC 40985022731
|
| Hospital Charge Code |
10774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.66 |
| Max. Negotiated Rate |
$192.26 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Medicare |
$55.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.76
|
| Rate for Payer: BCBS Complete |
$39.54
|
| Rate for Payer: BCBS MAPPO |
$53.41
|
| Rate for Payer: BCBS Trust/PPO |
$175.62
|
| Rate for Payer: BCN Commercial |
$175.62
|
| Rate for Payer: BCN Medicare Advantage |
$53.41
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cofinity Commercial |
$183.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.41
|
| Rate for Payer: Healthscope Commercial |
$192.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.22
|
| Rate for Payer: Mclaren Medicaid |
$37.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.08
|
| Rate for Payer: Meridian Medicaid |
$39.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.58
|
| Rate for Payer: Nomi Health Commercial |
$175.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.22
|
| Rate for Payer: PACE Senior Care Partners |
$50.73
|
| Rate for Payer: PACE SWMI |
$53.41
|
| Rate for Payer: PHP Commercial |
$181.58
|
| Rate for Payer: PHP Medicare Advantage |
$53.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$185.85
|
| Rate for Payer: Priority Health Medicare |
$53.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.68
|
| Rate for Payer: Railroad Medicare Medicare |
$53.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.99
|
| Rate for Payer: UHC Core |
$178.37
|
| Rate for Payer: UHC Exchange |
$53.41
|
| Rate for Payer: UHC Medicaid |
$37.66
|
| Rate for Payer: UHC Medicare Advantage |
$53.41
|
| Rate for Payer: UHCCP Medicaid |
$37.66
|
| Rate for Payer: VA VA |
$53.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.22
|
|
|
OMEGA-3 FATTY ACIDS-FISH OIL 300 MG-1,000 MG CAPSULE
|
Facility
|
IP
|
$213.62
|
|
|
Service Code
|
NDC 40985022731
|
| Hospital Charge Code |
10774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$192.26 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: BCBS Trust/PPO |
$176.43
|
| Rate for Payer: BCN Commercial |
$176.43
|
| Rate for Payer: Cash Price |
$170.90
|
| Rate for Payer: Cofinity Commercial |
$183.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.90
|
| Rate for Payer: Healthscope Commercial |
$192.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.58
|
| Rate for Payer: Nomi Health Commercial |
$175.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.22
|
| Rate for Payer: PHP Commercial |
$181.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$185.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.99
|
| Rate for Payer: UHC Core |
$178.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.22
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,083.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,449.91 |
| Max. Negotiated Rate |
$1,874.88 |
| Rate for Payer: Aetna Commercial |
$1,770.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,720.51
|
| Rate for Payer: BCN Commercial |
$1,720.51
|
| Rate for Payer: Cash Price |
$1,666.56
|
| Rate for Payer: Cofinity Commercial |
$1,791.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,666.56
|
| Rate for Payer: Healthscope Commercial |
$1,874.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,562.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,770.72
|
| Rate for Payer: Nomi Health Commercial |
$1,708.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,562.40
|
| Rate for Payer: PHP Commercial |
$1,770.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,812.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,449.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,833.22
|
| Rate for Payer: UHC Core |
$1,739.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,562.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,083.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$367.27 |
| Max. Negotiated Rate |
$1,874.88 |
| Rate for Payer: Aetna Commercial |
$1,770.72
|
| Rate for Payer: Aetna Medicare |
$541.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$651.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$651.00
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS MAPPO |
$520.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,712.60
|
| Rate for Payer: BCN Commercial |
$1,712.60
|
| Rate for Payer: BCN Medicare Advantage |
$520.80
|
| Rate for Payer: Cash Price |
$1,666.56
|
| Rate for Payer: Cofinity Commercial |
$1,791.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,666.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.80
|
| Rate for Payer: Healthscope Commercial |
$1,874.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,562.40
|
| Rate for Payer: Mclaren Medicaid |
$367.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.84
|
| Rate for Payer: Meridian Medicaid |
$385.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$598.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,770.72
|
| Rate for Payer: Nomi Health Commercial |
$1,708.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,562.40
|
| Rate for Payer: PACE Senior Care Partners |
$494.76
|
| Rate for Payer: PACE SWMI |
$520.80
|
| Rate for Payer: PHP Commercial |
$1,770.72
|
| Rate for Payer: PHP Medicare Advantage |
$520.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,812.38
|
| Rate for Payer: Priority Health Medicare |
$526.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,449.91
|
| Rate for Payer: Railroad Medicare Medicare |
$520.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,833.22
|
| Rate for Payer: UHC Core |
$1,739.47
|
| Rate for Payer: UHC Exchange |
$520.80
|
| Rate for Payer: UHC Medicaid |
$367.27
|
| Rate for Payer: UHC Medicare Advantage |
$520.80
|
| Rate for Payer: UHCCP Medicaid |
$367.27
|
| Rate for Payer: VA VA |
$520.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,562.40
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: Aetna Medicare |
$17.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.75
|
| Rate for Payer: BCBS Complete |
$12.29
|
| Rate for Payer: BCBS MAPPO |
$16.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.60
|
| Rate for Payer: BCN Commercial |
$54.60
|
| Rate for Payer: BCN Medicare Advantage |
$16.60
|
| 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: Health Alliance Plan Medicare Advantage |
$16.60
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.81
|
| Rate for Payer: Mclaren Medicaid |
$11.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.43
|
| Rate for Payer: Meridian Medicaid |
$12.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.45
|
| Rate for Payer: Nomi Health Commercial |
$54.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.81
|
| Rate for Payer: PACE Senior Care Partners |
$15.77
|
| Rate for Payer: PACE SWMI |
$16.60
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: PHP Medicare Advantage |
$16.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.78
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.22
|
| Rate for Payer: Railroad Medicare Medicare |
$16.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.44
|
| Rate for Payer: UHC Core |
$55.45
|
| Rate for Payer: UHC Exchange |
$16.60
|
| Rate for Payer: UHC Medicaid |
$11.71
|
| Rate for Payer: UHC Medicare Advantage |
$16.60
|
| Rate for Payer: UHCCP Medicaid |
$11.71
|
| Rate for Payer: VA VA |
$16.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.81
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Nomi Health Commercial |
$3.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.10
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 16714020010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: Aetna Medicare |
$1.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| 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: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: Meridian Medicaid |
$0.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PACE Senior Care Partners |
$1.01
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$127.61
|
|
|
Service Code
|
NDC 16714020030
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$114.85 |
| Rate for Payer: Aetna Commercial |
$108.47
|
| Rate for Payer: BCBS Trust/PPO |
$105.39
|
| Rate for Payer: BCN Commercial |
$105.39
|
| 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 Commercial |
$108.47
|
| Rate for Payer: Nomi Health Commercial |
$104.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.71
|
| Rate for Payer: PHP Commercial |
$108.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.82
|
| 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
|
$4.26
|
|
|
Service Code
|
NDC 16714020010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.52
|
| 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 |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.96
|
| 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 |
$3.19
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: Aetna Medicare |
$36.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.62
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS MAPPO |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$114.76
|
| Rate for Payer: BCN Commercial |
$114.76
|
| Rate for Payer: BCN Medicare Advantage |
$34.90
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.90
|
| Rate for Payer: Healthscope Commercial |
$125.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.69
|
| Rate for Payer: Mclaren Medicaid |
$24.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.64
|
| Rate for Payer: Meridian Medicaid |
$25.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: PACE Senior Care Partners |
$33.15
|
| Rate for Payer: PACE SWMI |
$34.90
|
| Rate for Payer: PHP Commercial |
$118.65
|
| Rate for Payer: PHP Medicare Advantage |
$34.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.44
|
| Rate for Payer: Priority Health Medicare |
$35.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.15
|
| Rate for Payer: Railroad Medicare Medicare |
$34.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.84
|
| Rate for Payer: UHC Core |
$116.56
|
| Rate for Payer: UHC Exchange |
$34.90
|
| Rate for Payer: UHC Medicaid |
$24.61
|
| Rate for Payer: UHC Medicare Advantage |
$34.90
|
| Rate for Payer: UHCCP Medicaid |
$24.61
|
| Rate for Payer: VA VA |
$34.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.69
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$127.61
|
|
|
Service Code
|
NDC 16714020030
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$114.85 |
| Rate for Payer: Aetna Commercial |
$108.47
|
| Rate for Payer: Aetna Medicare |
$33.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.88
|
| Rate for Payer: BCBS Complete |
$23.62
|
| Rate for Payer: BCBS MAPPO |
$31.90
|
| Rate for Payer: BCBS Trust/PPO |
$104.91
|
| Rate for Payer: BCN Commercial |
$104.91
|
| Rate for Payer: BCN Medicare Advantage |
$31.90
|
| 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: Health Alliance Plan Medicare Advantage |
$31.90
|
| Rate for Payer: Healthscope Commercial |
$114.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.71
|
| Rate for Payer: Mclaren Medicaid |
$22.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.50
|
| Rate for Payer: Meridian Medicaid |
$23.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.47
|
| Rate for Payer: Nomi Health Commercial |
$104.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.71
|
| Rate for Payer: PACE Senior Care Partners |
$30.31
|
| Rate for Payer: PACE SWMI |
$31.90
|
| Rate for Payer: PHP Commercial |
$108.47
|
| Rate for Payer: PHP Medicare Advantage |
$31.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$111.02
|
| Rate for Payer: Priority Health Medicare |
$32.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.82
|
| Rate for Payer: Railroad Medicare Medicare |
$31.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.30
|
| Rate for Payer: UHC Core |
$106.55
|
| Rate for Payer: UHC Exchange |
$31.90
|
| Rate for Payer: UHC Medicaid |
$22.50
|
| Rate for Payer: UHC Medicare Advantage |
$31.90
|
| Rate for Payer: UHCCP Medicaid |
$22.50
|
| Rate for Payer: VA VA |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.71
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: BCBS Trust/PPO |
$54.85
|
| Rate for Payer: BCN Commercial |
$54.85
|
| 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 Commercial |
$56.45
|
| Rate for Payer: Nomi Health Commercial |
$54.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.81
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.22
|
| 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
|
$139.59
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.15 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: BCBS Trust/PPO |
$115.29
|
| Rate for Payer: BCN Commercial |
$115.29
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Healthscope Commercial |
$125.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Nomi Health Commercial |
$114.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: PHP Commercial |
$118.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$121.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.84
|
| Rate for Payer: UHC Core |
$116.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.69
|
|
