|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$53.89
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.03 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCBS Trust/PPO |
$63.57
|
| Rate for Payer: BCBS Trust/PPO |
$127.25
|
| Rate for Payer: BCBS Trust/PPO |
$92.93
|
| Rate for Payer: BCN Commercial |
$41.65
|
| Rate for Payer: BCN Commercial |
$87.98
|
| Rate for Payer: BCN Commercial |
$60.19
|
| Rate for Payer: BCN Commercial |
$120.47
|
| Rate for Payer: Cash Price |
$124.71
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Commercial |
$66.98
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Healthscope Commercial |
$70.09
|
| Rate for Payer: Healthscope Commercial |
$140.30
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.20
|
| Rate for Payer: Nomi Health Commercial |
$93.35
|
| Rate for Payer: Nomi Health Commercial |
$127.83
|
| Rate for Payer: Nomi Health Commercial |
$63.86
|
| Rate for Payer: Nomi Health Commercial |
$44.19
|
| Rate for Payer: PHP Commercial |
$132.51
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$66.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.03
|
| Rate for Payer: Priority Health HMO/PPO |
$46.88
|
| Rate for Payer: Priority Health HMO/PPO |
$67.76
|
| Rate for Payer: Priority Health HMO/PPO |
$99.04
|
| Rate for Payer: Priority Health HMO/PPO |
$135.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.42
|
| Rate for Payer: UHC Core |
$45.00
|
| Rate for Payer: UHC Core |
$65.03
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Core |
$95.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$113.84
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.04 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Medicare |
$40.53
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: Aetna Medicare |
$14.01
|
| Rate for Payer: Aetna Medicare |
$20.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.58
|
| Rate for Payer: BCBS Complete |
$45.54
|
| Rate for Payer: BCBS Complete |
$62.36
|
| Rate for Payer: BCBS Complete |
$31.15
|
| Rate for Payer: BCBS Complete |
$21.56
|
| Rate for Payer: BCBS MAPPO |
$28.46
|
| Rate for Payer: BCBS MAPPO |
$38.97
|
| Rate for Payer: BCBS MAPPO |
$19.47
|
| Rate for Payer: BCBS MAPPO |
$13.47
|
| Rate for Payer: BCBS Trust/PPO |
$93.59
|
| Rate for Payer: BCBS Trust/PPO |
$64.03
|
| Rate for Payer: BCBS Trust/PPO |
$128.16
|
| Rate for Payer: BCBS Trust/PPO |
$44.30
|
| Rate for Payer: BCN Commercial |
$88.51
|
| Rate for Payer: BCN Commercial |
$41.90
|
| Rate for Payer: BCN Commercial |
$121.20
|
| Rate for Payer: BCN Commercial |
$60.55
|
| Rate for Payer: BCN Medicare Advantage |
$38.97
|
| Rate for Payer: BCN Medicare Advantage |
$19.47
|
| Rate for Payer: BCN Medicare Advantage |
$28.46
|
| Rate for Payer: BCN Medicare Advantage |
$13.47
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$124.71
|
| Rate for Payer: Cofinity Commercial |
$66.98
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.47
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Healthscope Commercial |
$70.09
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$140.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Nomi Health Commercial |
$44.19
|
| Rate for Payer: Nomi Health Commercial |
$63.86
|
| Rate for Payer: Nomi Health Commercial |
$93.35
|
| Rate for Payer: Nomi Health Commercial |
$127.83
|
| Rate for Payer: PACE Senior Care Partners |
$27.04
|
| Rate for Payer: PACE Senior Care Partners |
$12.80
|
| Rate for Payer: PACE Senior Care Partners |
$18.50
|
| Rate for Payer: PACE Senior Care Partners |
$37.02
|
| Rate for Payer: PACE SWMI |
$38.97
|
| Rate for Payer: PACE SWMI |
$28.46
|
| Rate for Payer: PACE SWMI |
$13.47
|
| Rate for Payer: PACE SWMI |
$19.47
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$66.20
|
| Rate for Payer: PHP Commercial |
$132.51
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: PHP Medicare Advantage |
$38.97
|
| Rate for Payer: PHP Medicare Advantage |
$28.46
|
| Rate for Payer: PHP Medicare Advantage |
$19.47
|
| Rate for Payer: PHP Medicare Advantage |
$13.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health HMO/PPO |
$135.62
|
| Rate for Payer: Priority Health HMO/PPO |
$67.76
|
| Rate for Payer: Priority Health HMO/PPO |
$46.88
|
| Rate for Payer: Priority Health HMO/PPO |
$99.04
|
| Rate for Payer: Priority Health Medicare |
$13.61
|
| Rate for Payer: Priority Health Medicare |
$28.74
|
| Rate for Payer: Priority Health Medicare |
$39.36
|
| Rate for Payer: Priority Health Medicare |
$19.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.27
|
| Rate for Payer: Railroad Medicare Medicare |
$38.97
|
| Rate for Payer: Railroad Medicare Medicare |
$13.47
|
| Rate for Payer: Railroad Medicare Medicare |
$28.46
|
| Rate for Payer: Railroad Medicare Medicare |
$19.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.18
|
| Rate for Payer: UHC Core |
$95.06
|
| Rate for Payer: UHC Core |
$65.03
|
| Rate for Payer: UHC Core |
$130.17
|
| Rate for Payer: UHC Core |
$45.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.97
|
| Rate for Payer: UHC Exchange |
$19.47
|
| Rate for Payer: UHC Exchange |
$38.97
|
| Rate for Payer: UHC Exchange |
$28.46
|
| Rate for Payer: UHC Exchange |
$13.47
|
| Rate for Payer: UHC Medicare Advantage |
$19.47
|
| Rate for Payer: UHC Medicare Advantage |
$28.46
|
| Rate for Payer: UHC Medicare Advantage |
$13.47
|
| Rate for Payer: UHC Medicare Advantage |
$38.97
|
| Rate for Payer: VA VA |
$38.97
|
| Rate for Payer: VA VA |
$19.47
|
| Rate for Payer: VA VA |
$13.47
|
| Rate for Payer: VA VA |
$28.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
IP
|
$70.97
|
|
|
Service Code
|
NDC 43598016630
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.13 |
| Max. Negotiated Rate |
$63.87 |
| Rate for Payer: Aetna Commercial |
$60.32
|
| Rate for Payer: BCBS Trust/PPO |
$57.93
|
| Rate for Payer: BCN Commercial |
$54.85
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.78
|
| Rate for Payer: Healthscope Commercial |
$63.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.32
|
| Rate for Payer: Nomi Health Commercial |
$58.20
|
| Rate for Payer: PHP Commercial |
$60.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.13
|
| Rate for Payer: Priority Health HMO/PPO |
$61.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.45
|
| Rate for Payer: UHC Core |
$59.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.23
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
OP
|
$70.97
|
|
|
Service Code
|
NDC 43598016630
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$63.87 |
| Rate for Payer: Aetna Commercial |
$60.32
|
| Rate for Payer: Aetna Medicare |
$18.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.18
|
| Rate for Payer: BCBS Complete |
$28.39
|
| Rate for Payer: BCBS MAPPO |
$17.74
|
| Rate for Payer: BCBS Trust/PPO |
$58.34
|
| Rate for Payer: BCN Commercial |
$55.18
|
| Rate for Payer: BCN Medicare Advantage |
$17.74
|
| Rate for Payer: Cash Price |
$56.78
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$63.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.32
|
| Rate for Payer: Nomi Health Commercial |
$58.20
|
| Rate for Payer: PACE Senior Care Partners |
$16.86
|
| Rate for Payer: PACE SWMI |
$17.74
|
| Rate for Payer: PHP Commercial |
$60.32
|
| Rate for Payer: PHP Medicare Advantage |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.13
|
| Rate for Payer: Priority Health HMO/PPO |
$61.74
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.55
|
| Rate for Payer: Railroad Medicare Medicare |
$17.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.45
|
| Rate for Payer: UHC Core |
$59.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.74
|
| Rate for Payer: UHC Exchange |
$17.74
|
| Rate for Payer: UHC Medicare Advantage |
$17.74
|
| Rate for Payer: VA VA |
$17.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.23
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 60505311000
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.44 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna Medicare |
$78.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.00
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS MAPPO |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$247.29
|
| Rate for Payer: BCN Commercial |
$233.87
|
| Rate for Payer: BCN Medicare Advantage |
$75.20
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: Nomi Health Commercial |
$246.66
|
| Rate for Payer: PACE Senior Care Partners |
$71.44
|
| Rate for Payer: PACE SWMI |
$75.20
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health HMO/PPO |
$261.70
|
| Rate for Payer: Priority Health Medicare |
$75.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.54
|
| Rate for Payer: Railroad Medicare Medicare |
$75.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.70
|
| Rate for Payer: UHC Core |
$251.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.20
|
| Rate for Payer: UHC Exchange |
$75.20
|
| Rate for Payer: UHC Medicare Advantage |
$75.20
|
| Rate for Payer: VA VA |
$75.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 60505311000
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.52 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: BCBS Trust/PPO |
$245.54
|
| Rate for Payer: BCN Commercial |
$232.46
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: Nomi Health Commercial |
$246.66
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health HMO/PPO |
$261.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.70
|
| Rate for Payer: UHC Core |
$251.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00904628361
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$70.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| Rate for Payer: BCBS MAPPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$224.10
|
| Rate for Payer: BCN Commercial |
$211.95
|
| Rate for Payer: BCN Medicare Advantage |
$68.15
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.15
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PACE Senior Care Partners |
$64.74
|
| Rate for Payer: PACE SWMI |
$68.15
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Medicare |
$68.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| Rate for Payer: Railroad Medicare Medicare |
$68.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.15
|
| Rate for Payer: UHC Exchange |
$68.15
|
| Rate for Payer: UHC Medicare Advantage |
$68.15
|
| Rate for Payer: VA VA |
$68.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00904628361
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.19 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: BCBS Trust/PPO |
$222.52
|
| Rate for Payer: BCN Commercial |
$210.67
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: Nomi Health Commercial |
$223.53
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health HMO/PPO |
$237.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.89
|
| Rate for Payer: UHC Core |
$227.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCN Commercial |
$5.97
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: Nomi Health Commercial |
$6.33
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health HMO/PPO |
$6.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.79
|
| Rate for Payer: UHC Core |
$6.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$114.63
|
|
|
Service Code
|
NDC 49884032055
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.51 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: BCBS Trust/PPO |
$93.57
|
| Rate for Payer: BCN Commercial |
$88.59
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.70
|
| Rate for Payer: Healthscope Commercial |
$103.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: Nomi Health Commercial |
$94.00
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.51
|
| Rate for Payer: Priority Health HMO/PPO |
$99.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.87
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
NDC 49884032052
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.20
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: BCBS MAPPO |
$0.96
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Medicare Advantage |
$0.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.96
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: PACE Senior Care Partners |
$0.91
|
| Rate for Payer: PACE SWMI |
$0.96
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health HMO/PPO |
$3.33
|
| Rate for Payer: Priority Health Medicare |
$0.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.96
|
| Rate for Payer: UHC Exchange |
$0.96
|
| Rate for Payer: UHC Medicare Advantage |
$0.96
|
| Rate for Payer: VA VA |
$0.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$68.69
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Aetna Commercial |
$58.39
|
| Rate for Payer: Aetna Medicare |
$17.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.47
|
| Rate for Payer: BCBS Complete |
$27.48
|
| Rate for Payer: BCBS MAPPO |
$17.17
|
| Rate for Payer: BCBS Trust/PPO |
$56.47
|
| Rate for Payer: BCN Commercial |
$53.41
|
| Rate for Payer: BCN Medicare Advantage |
$17.17
|
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Cofinity Commercial |
$59.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$61.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.39
|
| Rate for Payer: Nomi Health Commercial |
$56.33
|
| Rate for Payer: PACE Senior Care Partners |
$16.31
|
| Rate for Payer: PACE SWMI |
$17.17
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: PHP Medicare Advantage |
$17.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.65
|
| Rate for Payer: Priority Health HMO/PPO |
$59.76
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.02
|
| Rate for Payer: Railroad Medicare Medicare |
$17.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.45
|
| Rate for Payer: UHC Core |
$57.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.17
|
| Rate for Payer: UHC Exchange |
$17.17
|
| Rate for Payer: UHC Medicare Advantage |
$17.17
|
| Rate for Payer: VA VA |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.52
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$117.08
|
|
|
Service Code
|
NDC 00378551093
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.81 |
| Max. Negotiated Rate |
$105.37 |
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.59
|
| Rate for Payer: BCBS Complete |
$46.83
|
| Rate for Payer: BCBS MAPPO |
$29.27
|
| Rate for Payer: BCBS Trust/PPO |
$96.25
|
| Rate for Payer: BCN Commercial |
$91.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.27
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.27
|
| Rate for Payer: Healthscope Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.52
|
| Rate for Payer: Nomi Health Commercial |
$96.01
|
| Rate for Payer: PACE Senior Care Partners |
$27.81
|
| Rate for Payer: PACE SWMI |
$29.27
|
| Rate for Payer: PHP Commercial |
$99.52
|
| Rate for Payer: PHP Medicare Advantage |
$29.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.10
|
| Rate for Payer: Priority Health HMO/PPO |
$101.86
|
| Rate for Payer: Priority Health Medicare |
$29.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.44
|
| Rate for Payer: Railroad Medicare Medicare |
$29.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.03
|
| Rate for Payer: UHC Core |
$97.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.27
|
| Rate for Payer: UHC Exchange |
$29.27
|
| Rate for Payer: UHC Medicare Advantage |
$29.27
|
| Rate for Payer: VA VA |
$29.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.81
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$231.56
|
|
|
Service Code
|
NDC 55111026281
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$208.40 |
| Rate for Payer: Aetna Commercial |
$196.83
|
| Rate for Payer: Aetna Medicare |
$60.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.36
|
| Rate for Payer: BCBS Complete |
$92.62
|
| Rate for Payer: BCBS MAPPO |
$57.89
|
| Rate for Payer: BCBS Trust/PPO |
$190.37
|
| Rate for Payer: BCN Commercial |
$180.04
|
| Rate for Payer: BCN Medicare Advantage |
$57.89
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.89
|
| Rate for Payer: Healthscope Commercial |
$208.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.83
|
| Rate for Payer: Nomi Health Commercial |
$189.88
|
| Rate for Payer: PACE Senior Care Partners |
$55.00
|
| Rate for Payer: PACE SWMI |
$57.89
|
| Rate for Payer: PHP Commercial |
$196.83
|
| Rate for Payer: PHP Medicare Advantage |
$57.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.51
|
| Rate for Payer: Priority Health HMO/PPO |
$201.46
|
| Rate for Payer: Priority Health Medicare |
$58.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.15
|
| Rate for Payer: Railroad Medicare Medicare |
$57.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.77
|
| Rate for Payer: UHC Core |
$193.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.89
|
| Rate for Payer: UHC Exchange |
$57.89
|
| Rate for Payer: UHC Medicare Advantage |
$57.89
|
| Rate for Payer: VA VA |
$57.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.67
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$117.08
|
|
|
Service Code
|
NDC 00378551093
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.10 |
| Max. Negotiated Rate |
$105.37 |
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: BCBS Trust/PPO |
$95.57
|
| Rate for Payer: BCN Commercial |
$90.48
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$105.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.52
|
| Rate for Payer: Nomi Health Commercial |
$96.01
|
| Rate for Payer: PHP Commercial |
$99.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.10
|
| Rate for Payer: Priority Health HMO/PPO |
$101.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.03
|
| Rate for Payer: UHC Core |
$97.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.81
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.41
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: BCBS MAPPO |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$6.35
|
| Rate for Payer: BCN Commercial |
$6.00
|
| Rate for Payer: BCN Medicare Advantage |
$1.93
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: Nomi Health Commercial |
$6.33
|
| Rate for Payer: PACE Senior Care Partners |
$1.83
|
| Rate for Payer: PACE SWMI |
$1.93
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: PHP Medicare Advantage |
$1.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health HMO/PPO |
$6.72
|
| Rate for Payer: Priority Health Medicare |
$1.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.79
|
| Rate for Payer: UHC Core |
$6.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.93
|
| Rate for Payer: UHC Exchange |
$1.93
|
| Rate for Payer: UHC Medicare Advantage |
$1.93
|
| Rate for Payer: VA VA |
$1.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$68.69
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Aetna Commercial |
$58.39
|
| Rate for Payer: BCBS Trust/PPO |
$56.07
|
| Rate for Payer: BCN Commercial |
$53.08
|
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Cofinity Commercial |
$59.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.95
|
| Rate for Payer: Healthscope Commercial |
$61.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.39
|
| Rate for Payer: Nomi Health Commercial |
$56.33
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.65
|
| Rate for Payer: Priority Health HMO/PPO |
$59.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.45
|
| Rate for Payer: UHC Core |
$57.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.52
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$231.56
|
|
|
Service Code
|
NDC 55111026281
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.51 |
| Max. Negotiated Rate |
$208.40 |
| Rate for Payer: Aetna Commercial |
$196.83
|
| Rate for Payer: BCBS Trust/PPO |
$189.02
|
| Rate for Payer: BCN Commercial |
$178.95
|
| Rate for Payer: Cash Price |
$185.25
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.25
|
| Rate for Payer: Healthscope Commercial |
$208.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.83
|
| Rate for Payer: Nomi Health Commercial |
$189.88
|
| Rate for Payer: PHP Commercial |
$196.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.51
|
| Rate for Payer: Priority Health HMO/PPO |
$201.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.77
|
| Rate for Payer: UHC Core |
$193.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.67
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 49884032052
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$3.13
|
| Rate for Payer: BCN Commercial |
$2.96
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Nomi Health Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health HMO/PPO |
$3.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.37
|
| Rate for Payer: UHC Core |
$3.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$114.63
|
|
|
Service Code
|
NDC 49884032055
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna Medicare |
$29.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.82
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS MAPPO |
$28.66
|
| Rate for Payer: BCBS Trust/PPO |
$94.24
|
| Rate for Payer: BCN Commercial |
$89.12
|
| Rate for Payer: BCN Medicare Advantage |
$28.66
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$103.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: Nomi Health Commercial |
$94.00
|
| Rate for Payer: PACE Senior Care Partners |
$27.22
|
| Rate for Payer: PACE SWMI |
$28.66
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: PHP Medicare Advantage |
$28.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.51
|
| Rate for Payer: Priority Health HMO/PPO |
$99.73
|
| Rate for Payer: Priority Health Medicare |
$28.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.80
|
| Rate for Payer: Railroad Medicare Medicare |
$28.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.87
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.66
|
| Rate for Payer: UHC Exchange |
$28.66
|
| Rate for Payer: UHC Medicare Advantage |
$28.66
|
| Rate for Payer: VA VA |
$28.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.61 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: BCBS Trust/PPO |
$216.77
|
| Rate for Payer: BCN Commercial |
$205.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health HMO/PPO |
$231.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.68
|
| Rate for Payer: UHC Core |
$221.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.07 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$69.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.98
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: BCBS MAPPO |
$66.39
|
| Rate for Payer: BCBS Trust/PPO |
$218.31
|
| Rate for Payer: BCN Commercial |
$206.47
|
| Rate for Payer: BCN Medicare Advantage |
$66.39
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.39
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: PACE Senior Care Partners |
$63.07
|
| Rate for Payer: PACE SWMI |
$66.39
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health HMO/PPO |
$231.03
|
| Rate for Payer: Priority Health Medicare |
$67.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.92
|
| Rate for Payer: Railroad Medicare Medicare |
$66.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.68
|
| Rate for Payer: UHC Core |
$221.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.39
|
| Rate for Payer: UHC Exchange |
$66.39
|
| Rate for Payer: UHC Medicare Advantage |
$66.39
|
| Rate for Payer: VA VA |
$66.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.56 |
| 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 |
$122.20
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$237.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| 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 Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health HMO/PPO |
$265.78
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.68
|
| 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 Dual Complete DSNP |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| 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 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.58 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$249.38
|
| Rate for Payer: BCN Commercial |
$236.09
|
| 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: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health HMO/PPO |
$265.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.68
|
| 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
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$31.33
|
|
|
Service Code
|
NDC 43598076507
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Aetna Commercial |
$26.63
|
| Rate for Payer: BCBS Trust/PPO |
$25.57
|
| 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 Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$25.69
|
| Rate for Payer: PHP Commercial |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health HMO/PPO |
$27.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.99
|
| 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
|
|
