|
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
|
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
|
$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
|
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
|
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
|
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
|
$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 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
|
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
|
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 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
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.57 |
| 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 |
$198.57
|
| Rate for Payer: Priority Health HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.69
|
| 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
|
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
|
$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 |
$198.57
|
| Rate for Payer: Priority Health HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.69
|
| 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
|
|
|
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
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$43.23
|
|
|
Service Code
|
NDC 00536130840
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$38.91 |
| Rate for Payer: Aetna Commercial |
$36.75
|
| Rate for Payer: Aetna Medicare |
$11.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.51
|
| Rate for Payer: BCBS Complete |
$17.29
|
| Rate for Payer: BCBS MAPPO |
$10.81
|
| Rate for Payer: BCBS Trust/PPO |
$35.54
|
| Rate for Payer: BCN Commercial |
$33.61
|
| Rate for Payer: BCN Medicare Advantage |
$10.81
|
| Rate for Payer: Cash Price |
$34.58
|
| Rate for Payer: Cofinity Commercial |
$37.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.81
|
| Rate for Payer: Healthscope Commercial |
$38.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.75
|
| Rate for Payer: Nomi Health Commercial |
$35.45
|
| Rate for Payer: PACE Senior Care Partners |
$10.27
|
| Rate for Payer: PACE SWMI |
$10.81
|
| Rate for Payer: PHP Commercial |
$36.75
|
| Rate for Payer: PHP Medicare Advantage |
$10.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.10
|
| Rate for Payer: Priority Health HMO/PPO |
$37.61
|
| Rate for Payer: Priority Health Medicare |
$10.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.96
|
| Rate for Payer: Railroad Medicare Medicare |
$10.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.04
|
| Rate for Payer: UHC Core |
$36.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.81
|
| Rate for Payer: UHC Exchange |
$10.81
|
| Rate for Payer: UHC Medicare Advantage |
$10.81
|
| Rate for Payer: VA VA |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.42
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$31.33
|
|
|
Service Code
|
NDC 43598076507
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.44 |
| 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 |
$12.53
|
| Rate for Payer: BCBS MAPPO |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$25.76
|
| Rate for Payer: BCN Commercial |
$24.36
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.63
|
| Rate for Payer: Nomi Health Commercial |
$25.69
|
| 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 Cigna Priority Health |
$20.36
|
| Rate for Payer: Priority Health HMO/PPO |
$27.26
|
| Rate for Payer: Priority Health Medicare |
$7.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.99
|
| 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 Dual Complete DSNP |
$7.83
|
| Rate for Payer: UHC Exchange |
$7.83
|
| Rate for Payer: UHC Medicare Advantage |
$7.83
|
| Rate for Payer: VA VA |
$7.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.50
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$43.23
|
|
|
Service Code
|
NDC 00536130840
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$38.91 |
| Rate for Payer: Aetna Commercial |
$36.75
|
| Rate for Payer: BCBS Trust/PPO |
$35.29
|
| Rate for Payer: BCN Commercial |
$33.41
|
| Rate for Payer: Cash Price |
$34.58
|
| Rate for Payer: Cofinity Commercial |
$37.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.58
|
| Rate for Payer: Healthscope Commercial |
$38.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.75
|
| Rate for Payer: Nomi Health Commercial |
$35.45
|
| Rate for Payer: PHP Commercial |
$36.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.10
|
| Rate for Payer: Priority Health HMO/PPO |
$37.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.04
|
| Rate for Payer: UHC Core |
$36.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.42
|
|
|
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 |
$282.67 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: BCBS Trust/PPO |
$354.99
|
| Rate for Payer: BCN Commercial |
$336.08
|
| 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: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.67
|
| Rate for Payer: Priority Health HMO/PPO |
$378.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.37
|
| 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 |
$103.28 |
| 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 |
$173.95
|
| Rate for Payer: BCBS MAPPO |
$108.72
|
| Rate for Payer: BCBS Trust/PPO |
$357.51
|
| Rate for Payer: BCN Commercial |
$338.12
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: Nomi Health Commercial |
$356.60
|
| 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 Cigna Priority Health |
$282.67
|
| Rate for Payer: Priority Health HMO/PPO |
$378.35
|
| Rate for Payer: Priority Health Medicare |
$109.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.37
|
| 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 Dual Complete DSNP |
$108.72
|
| Rate for Payer: UHC Exchange |
$108.72
|
| Rate for Payer: UHC Medicare Advantage |
$108.72
|
| 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
|
IP
|
$196.70
|
|
|
Service Code
|
NDC 40985022731
|
| Hospital Charge Code |
10774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.86 |
| Max. Negotiated Rate |
$177.03 |
| Rate for Payer: Aetna Commercial |
$167.19
|
| Rate for Payer: BCBS Trust/PPO |
$160.57
|
| Rate for Payer: BCN Commercial |
$152.01
|
| Rate for Payer: Cash Price |
$157.36
|
| Rate for Payer: Cofinity Commercial |
$169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.36
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.19
|
| Rate for Payer: Nomi Health Commercial |
$161.29
|
| Rate for Payer: PHP Commercial |
$167.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.86
|
| Rate for Payer: Priority Health HMO/PPO |
$171.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.10
|
| Rate for Payer: UHC Core |
$164.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.53
|
|
|
OMEGA-3 FATTY ACIDS-FISH OIL 300 MG-1,000 MG CAPSULE
|
Facility
|
OP
|
$196.70
|
|
|
Service Code
|
NDC 40985022731
|
| Hospital Charge Code |
10774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$177.03 |
| Rate for Payer: Aetna Commercial |
$167.19
|
| Rate for Payer: Aetna Medicare |
$51.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.47
|
| Rate for Payer: BCBS Complete |
$78.68
|
| Rate for Payer: BCBS MAPPO |
$49.17
|
| Rate for Payer: BCBS Trust/PPO |
$161.71
|
| Rate for Payer: BCN Commercial |
$152.93
|
| Rate for Payer: BCN Medicare Advantage |
$49.17
|
| Rate for Payer: Cash Price |
$157.36
|
| Rate for Payer: Cofinity Commercial |
$169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.17
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.19
|
| Rate for Payer: Nomi Health Commercial |
$161.29
|
| Rate for Payer: PACE Senior Care Partners |
$46.72
|
| Rate for Payer: PACE SWMI |
$49.17
|
| Rate for Payer: PHP Commercial |
$167.19
|
| Rate for Payer: PHP Medicare Advantage |
$49.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.86
|
| Rate for Payer: Priority Health HMO/PPO |
$171.13
|
| Rate for Payer: Priority Health Medicare |
$49.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.79
|
| Rate for Payer: Railroad Medicare Medicare |
$49.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.10
|
| Rate for Payer: UHC Core |
$164.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.17
|
| Rate for Payer: UHC Exchange |
$49.17
|
| Rate for Payer: UHC Medicare Advantage |
$49.17
|
| Rate for Payer: VA VA |
$49.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.53
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,067.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,757.12
|
| Rate for Payer: Aetna Medicare |
$537.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$646.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$646.00
|
| Rate for Payer: BCBS Complete |
$4.93
|
| Rate for Payer: BCBS MAPPO |
$516.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.45
|
| Rate for Payer: BCN Commercial |
$1,607.25
|
| Rate for Payer: BCN Medicare Advantage |
$516.80
|
| Rate for Payer: Cash Price |
$1,653.76
|
| Rate for Payer: Cash Price |
$1,653.76
|
| Rate for Payer: Cofinity Commercial |
$1,777.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,653.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.80
|
| Rate for Payer: Healthscope Commercial |
$1,860.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,550.40
|
| Rate for Payer: Mclaren Medicaid |
$4.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.64
|
| Rate for Payer: Meridian Medicaid |
$4.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$594.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.12
|
| Rate for Payer: Nomi Health Commercial |
$1,695.10
|
| Rate for Payer: PACE Senior Care Partners |
$490.96
|
| Rate for Payer: PACE SWMI |
$516.80
|
| Rate for Payer: PHP Commercial |
$1,757.12
|
| Rate for Payer: PHP Medicare Advantage |
$516.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,798.46
|
| Rate for Payer: Priority Health Medicare |
$521.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,385.02
|
| Rate for Payer: Railroad Medicare Medicare |
$516.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,819.14
|
| Rate for Payer: UHC Core |
$1,726.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.80
|
| Rate for Payer: UHC Exchange |
$516.80
|
| Rate for Payer: UHC Medicare Advantage |
$516.80
|
| Rate for Payer: UHCCP Medicaid |
$4.70
|
| Rate for Payer: VA VA |
$516.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,550.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,067.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,343.68 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna Commercial |
$1,757.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,687.46
|
| Rate for Payer: BCN Commercial |
$1,597.53
|
| Rate for Payer: Cash Price |
$1,653.76
|
| Rate for Payer: Cofinity Commercial |
$1,777.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,653.76
|
| Rate for Payer: Healthscope Commercial |
$1,860.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,550.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.12
|
| Rate for Payer: Nomi Health Commercial |
$1,695.10
|
| Rate for Payer: PHP Commercial |
$1,757.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.68
|
| Rate for Payer: Priority Health HMO/PPO |
$1,798.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,385.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,819.14
|
| Rate for Payer: UHC Core |
$1,726.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,550.40
|
|
