|
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
|
|
|
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
|
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
|
|
|
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 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 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 |
$167.20
|
| 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 |
$49.18
|
| Rate for Payer: BCBS Trust/PPO |
$161.71
|
| Rate for Payer: BCN Commercial |
$152.93
|
| Rate for Payer: BCN Medicare Advantage |
$49.18
|
| 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 |
$49.18
|
| Rate for Payer: Healthscope Commercial |
$177.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.52
|
| 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 |
$167.20
|
| Rate for Payer: Nomi Health Commercial |
$161.29
|
| Rate for Payer: PACE Senior Care Partners |
$46.72
|
| Rate for Payer: PACE SWMI |
$49.18
|
| Rate for Payer: PHP Commercial |
$167.20
|
| Rate for Payer: PHP Medicare Advantage |
$49.18
|
| 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 |
$49.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.10
|
| Rate for Payer: UHC Core |
$164.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.18
|
| Rate for Payer: UHC Exchange |
$49.18
|
| Rate for Payer: UHC Medicare Advantage |
$49.18
|
| Rate for Payer: VA VA |
$49.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.52
|
|
|
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 |
$167.20
|
| 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 |
$147.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.20
|
| Rate for Payer: Nomi Health Commercial |
$161.29
|
| Rate for Payer: PHP Commercial |
$167.20
|
| 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 |
$147.52
|
|
|
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 |
$4.68 |
| 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 |
$4.91
|
| 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 |
$4.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.64
|
| Rate for Payer: Meridian Medicaid |
$4.91
|
| 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 |
$4.68
|
| 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 |
$4.68
|
| 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
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$137.48
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$123.73 |
| Rate for Payer: Aetna Commercial |
$116.86
|
| Rate for Payer: BCBS Trust/PPO |
$112.22
|
| Rate for Payer: BCN Commercial |
$106.24
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$118.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$123.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: Nomi Health Commercial |
$112.73
|
| Rate for Payer: PHP Commercial |
$116.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: Priority Health HMO/PPO |
$119.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.98
|
| Rate for Payer: UHC Core |
$114.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.11
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 16714020010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| 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 |
$1.70
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.31
|
| 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 |
$3.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| 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 Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Medicare |
$1.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| 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 Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.77 |
| 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 |
$26.56
|
| Rate for Payer: BCBS MAPPO |
$16.60
|
| Rate for Payer: BCBS Trust/PPO |
$54.60
|
| Rate for Payer: BCN Commercial |
$51.63
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.45
|
| Rate for Payer: Nomi Health Commercial |
$54.46
|
| 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 Cigna Priority Health |
$43.17
|
| Rate for Payer: Priority Health HMO/PPO |
$57.78
|
| Rate for Payer: Priority Health Medicare |
$16.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.49
|
| 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 Dual Complete DSNP |
$16.60
|
| Rate for Payer: UHC Exchange |
$16.60
|
| Rate for Payer: UHC Medicare Advantage |
$16.60
|
| 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
|
$127.61
|
|
|
Service Code
|
NDC 16714020030
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$114.85 |
| Rate for Payer: Aetna Commercial |
$108.47
|
| Rate for Payer: BCBS Trust/PPO |
$104.17
|
| Rate for Payer: BCN Commercial |
$98.62
|
| Rate for Payer: Cash Price |
$102.09
|
| Rate for Payer: Cofinity Commercial |
$109.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.09
|
| Rate for Payer: Healthscope Commercial |
$114.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.47
|
| Rate for Payer: Nomi Health Commercial |
$104.64
|
| Rate for Payer: PHP Commercial |
$108.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.95
|
| Rate for Payer: Priority Health HMO/PPO |
$111.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.50
|
| 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
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.90
|
| Rate for Payer: Aetna Medicare |
$1.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.43
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.90
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO |
$3.99
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.04
|
| Rate for Payer: UHC Core |
$3.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.15
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.44
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$127.61
|
|
|
Service Code
|
NDC 16714020030
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.31 |
| 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 |
$51.04
|
| Rate for Payer: BCBS MAPPO |
$31.90
|
| Rate for Payer: BCBS Trust/PPO |
$104.91
|
| Rate for Payer: BCN Commercial |
$99.22
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.47
|
| Rate for Payer: Nomi Health Commercial |
$104.64
|
| 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 Cigna Priority Health |
$82.95
|
| Rate for Payer: Priority Health HMO/PPO |
$111.02
|
| Rate for Payer: Priority Health Medicare |
$32.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.50
|
| 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 Dual Complete DSNP |
$31.90
|
| Rate for Payer: UHC Exchange |
$31.90
|
| Rate for Payer: UHC Medicare Advantage |
$31.90
|
| Rate for Payer: VA VA |
$31.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.71
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$137.48
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.65 |
| Max. Negotiated Rate |
$123.73 |
| Rate for Payer: Aetna Commercial |
$116.86
|
| Rate for Payer: Aetna Medicare |
$35.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.96
|
| Rate for Payer: BCBS Complete |
$54.99
|
| Rate for Payer: BCBS MAPPO |
$34.37
|
| Rate for Payer: BCBS Trust/PPO |
$113.02
|
| Rate for Payer: BCN Commercial |
$106.89
|
| Rate for Payer: BCN Medicare Advantage |
$34.37
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$118.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.37
|
| Rate for Payer: Healthscope Commercial |
$123.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: Nomi Health Commercial |
$112.73
|
| Rate for Payer: PACE Senior Care Partners |
$32.65
|
| Rate for Payer: PACE SWMI |
$34.37
|
| Rate for Payer: PHP Commercial |
$116.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: Priority Health HMO/PPO |
$119.61
|
| Rate for Payer: Priority Health Medicare |
$34.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.11
|
| Rate for Payer: Railroad Medicare Medicare |
$34.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.98
|
| Rate for Payer: UHC Core |
$114.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.37
|
| Rate for Payer: UHC Exchange |
$34.37
|
| Rate for Payer: UHC Medicare Advantage |
$34.37
|
| Rate for Payer: VA VA |
$34.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.11
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 16714020010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.41
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.62
|
| Rate for Payer: Nomi Health Commercial |
$3.49
|
| Rate for Payer: PHP Commercial |
$3.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.77
|
| Rate for Payer: Priority Health HMO/PPO |
$3.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.75
|
| Rate for Payer: UHC Core |
$3.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: BCBS Trust/PPO |
$54.21
|
| Rate for Payer: BCN Commercial |
$51.32
|
| Rate for Payer: Cash Price |
$53.13
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.13
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.45
|
| Rate for Payer: Nomi Health Commercial |
$54.46
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.17
|
| Rate for Payer: Priority Health HMO/PPO |
$57.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.49
|
| 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 HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$46.66
|
|
|
Service Code
|
NDC 68094076359
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna Commercial |
$39.66
|
| Rate for Payer: Aetna Medicare |
$12.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.58
|
| Rate for Payer: BCBS Complete |
$18.66
|
| Rate for Payer: BCBS MAPPO |
$11.66
|
| Rate for Payer: BCBS Trust/PPO |
$38.36
|
| Rate for Payer: BCN Commercial |
$36.28
|
| Rate for Payer: BCN Medicare Advantage |
$11.66
|
| Rate for Payer: Cash Price |
$37.33
|
| Rate for Payer: Cofinity Commercial |
$40.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.66
|
| Rate for Payer: Healthscope Commercial |
$41.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.66
|
| Rate for Payer: Nomi Health Commercial |
$38.26
|
| Rate for Payer: PACE Senior Care Partners |
$11.08
|
| Rate for Payer: PACE SWMI |
$11.66
|
| Rate for Payer: PHP Commercial |
$39.66
|
| Rate for Payer: PHP Medicare Advantage |
$11.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.33
|
| Rate for Payer: Priority Health HMO/PPO |
$40.59
|
| Rate for Payer: Priority Health Medicare |
$11.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.26
|
| Rate for Payer: Railroad Medicare Medicare |
$11.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.06
|
| Rate for Payer: UHC Core |
$38.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.66
|
| Rate for Payer: UHC Exchange |
$11.66
|
| Rate for Payer: UHC Medicare Advantage |
$11.66
|
| Rate for Payer: VA VA |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.00
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$103.89 |
| Rate for Payer: Aetna Commercial |
$98.12
|
| Rate for Payer: Aetna Medicare |
$30.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.07
|
| Rate for Payer: BCBS Complete |
$46.17
|
| Rate for Payer: BCBS MAPPO |
$28.86
|
| Rate for Payer: BCBS Trust/PPO |
$94.90
|
| Rate for Payer: BCN Commercial |
$89.75
|
| Rate for Payer: BCN Medicare Advantage |
$28.86
|
| Rate for Payer: Cash Price |
$92.34
|
| Rate for Payer: Cofinity Commercial |
$99.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$103.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.12
|
| Rate for Payer: Nomi Health Commercial |
$94.65
|
| Rate for Payer: PACE Senior Care Partners |
$27.41
|
| Rate for Payer: PACE SWMI |
$28.86
|
| Rate for Payer: PHP Commercial |
$98.12
|
| Rate for Payer: PHP Medicare Advantage |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.03
|
| Rate for Payer: Priority Health HMO/PPO |
$100.42
|
| Rate for Payer: Priority Health Medicare |
$29.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.34
|
| Rate for Payer: Railroad Medicare Medicare |
$28.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.58
|
| Rate for Payer: UHC Core |
$96.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.86
|
| Rate for Payer: UHC Exchange |
$28.86
|
| Rate for Payer: UHC Medicare Advantage |
$28.86
|
| Rate for Payer: VA VA |
$28.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.57
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.81
|
|
|
Service Code
|
NDC 00904707341
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: BCBS Trust/PPO |
$39.03
|
| Rate for Payer: BCN Commercial |
$36.95
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$43.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.64
|
| Rate for Payer: Nomi Health Commercial |
$39.20
|
| Rate for Payer: PHP Commercial |
$40.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: Priority Health HMO/PPO |
$41.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.07
|
| Rate for Payer: UHC Core |
$39.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.86
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$40.48
|
|
|
Service Code
|
NDC 60687025240
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$36.43 |
| Rate for Payer: Aetna Commercial |
$34.41
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.65
|
| Rate for Payer: BCBS Complete |
$16.19
|
| Rate for Payer: BCBS MAPPO |
$10.12
|
| Rate for Payer: BCBS Trust/PPO |
$33.28
|
| Rate for Payer: BCN Commercial |
$31.47
|
| Rate for Payer: BCN Medicare Advantage |
$10.12
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$34.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$36.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.41
|
| Rate for Payer: Nomi Health Commercial |
$33.19
|
| Rate for Payer: PACE Senior Care Partners |
$9.61
|
| Rate for Payer: PACE SWMI |
$10.12
|
| Rate for Payer: PHP Commercial |
$34.41
|
| Rate for Payer: PHP Medicare Advantage |
$10.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.31
|
| Rate for Payer: Priority Health HMO/PPO |
$35.22
|
| Rate for Payer: Priority Health Medicare |
$10.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.12
|
| Rate for Payer: Railroad Medicare Medicare |
$10.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.62
|
| Rate for Payer: UHC Core |
$33.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.12
|
| Rate for Payer: UHC Exchange |
$10.12
|
| Rate for Payer: UHC Medicare Advantage |
$10.12
|
| Rate for Payer: VA VA |
$10.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.36
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$40.48
|
|
|
Service Code
|
NDC 60687025286
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$36.43 |
| Rate for Payer: Aetna Commercial |
$34.41
|
| Rate for Payer: BCBS Trust/PPO |
$33.04
|
| Rate for Payer: BCN Commercial |
$31.28
|
| Rate for Payer: Cash Price |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$34.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.38
|
| Rate for Payer: Healthscope Commercial |
$36.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.41
|
| Rate for Payer: Nomi Health Commercial |
$33.19
|
| Rate for Payer: PHP Commercial |
$34.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.31
|
| Rate for Payer: Priority Health HMO/PPO |
$35.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.62
|
| Rate for Payer: UHC Core |
$33.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.36
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.03 |
| Max. Negotiated Rate |
$103.89 |
| Rate for Payer: Aetna Commercial |
$98.12
|
| Rate for Payer: BCBS Trust/PPO |
$94.23
|
| Rate for Payer: BCN Commercial |
$89.20
|
| Rate for Payer: Cash Price |
$92.34
|
| Rate for Payer: Cofinity Commercial |
$99.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.34
|
| Rate for Payer: Healthscope Commercial |
$103.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.12
|
| Rate for Payer: Nomi Health Commercial |
$94.65
|
| Rate for Payer: PHP Commercial |
$98.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.03
|
| Rate for Payer: Priority Health HMO/PPO |
$100.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.58
|
| Rate for Payer: UHC Core |
$96.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.57
|
|
