|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$253.59
|
|
|
Service Code
|
NDC 0378-5512-93
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.58 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna American Axle |
$164.83
|
| Rate for Payer: Aetna Commercial |
$215.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.83
|
| Rate for Payer: Cash Price |
$202.87
|
| Rate for Payer: Cofinity Commercial |
$177.51
|
| Rate for Payer: Cofinity Commercial |
$218.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.87
|
| Rate for Payer: Healthscope Commercial |
$228.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.55
|
| Rate for Payer: PHP Commercial |
$215.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.51
|
| Rate for Payer: Priority Health SBD |
$159.76
|
| Rate for Payer: UMR Bronson Commercial |
$111.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$125.86
|
|
|
Service Code
|
NDC 0002-4455-01
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: Aetna American Axle |
$81.81
|
| Rate for Payer: Aetna Commercial |
$106.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.81
|
| Rate for Payer: Cash Price |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.69
|
| Rate for Payer: Healthscope Commercial |
$113.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.98
|
| Rate for Payer: PHP Commercial |
$106.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.10
|
| Rate for Payer: Priority Health SBD |
$79.29
|
| Rate for Payer: UMR Bronson Commercial |
$55.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.40
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$11.61
|
|
|
Service Code
|
NDC 55111-264-79
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.87
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.13
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 59746-308-12
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.80
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$400.27
|
|
|
Service Code
|
NDC 0093-5247-65
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$360.24 |
| Rate for Payer: Aetna American Axle |
$260.18
|
| Rate for Payer: Aetna Commercial |
$340.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.18
|
| Rate for Payer: Cash Price |
$320.22
|
| Rate for Payer: Cofinity Commercial |
$280.19
|
| Rate for Payer: Cofinity Commercial |
$344.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.22
|
| Rate for Payer: Healthscope Commercial |
$360.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.23
|
| Rate for Payer: PHP Commercial |
$340.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.19
|
| Rate for Payer: Priority Health SBD |
$252.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.20
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 49884-322-55
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.78
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$109.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.20
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 0904-6283-61
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 69543-380-30
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.10
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.14
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$88.07
|
|
|
Service Code
|
NDC 66993-680-30
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.75 |
| Max. Negotiated Rate |
$79.26 |
| Rate for Payer: Aetna American Axle |
$57.25
|
| Rate for Payer: Aetna Commercial |
$74.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.25
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$61.65
|
| Rate for Payer: Cofinity Commercial |
$75.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$79.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.86
|
| Rate for Payer: PHP Commercial |
$74.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.65
|
| Rate for Payer: Priority Health SBD |
$55.48
|
| Rate for Payer: UMR Bronson Commercial |
$38.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.05
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$246.75
|
|
|
Service Code
|
NDC 60505-3110-0
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$222.08 |
| Rate for Payer: Aetna American Axle |
$160.39
|
| Rate for Payer: Aetna Commercial |
$209.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.39
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cofinity Commercial |
$172.72
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.40
|
| Rate for Payer: Healthscope Commercial |
$222.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$185.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$209.74
|
| Rate for Payer: PHP Commercial |
$209.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.72
|
| Rate for Payer: Priority Health SBD |
$155.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$185.06
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 55111-163-30
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna American Axle |
$27.50
|
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.50
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.96
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: Priority Health SBD |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 33342-067-07
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.10
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.14
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 33342-083-07
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 49884-320-52
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$2.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$114.63
|
|
|
Service Code
|
NDC 60505-3275-3
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$80.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.44
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UMR Bronson Commercial |
$50.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$114.63
|
|
|
Service Code
|
NDC 49884-320-55
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$80.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$97.44
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.24
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UMR Bronson Commercial |
$50.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$8.31
|
|
|
Service Code
|
NDC 50268-615-11
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.48 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.65
|
| Rate for Payer: Healthscope Commercial |
$7.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.82
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.23
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$117.08
|
|
|
Service Code
|
NDC 0378-5510-93
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$105.37 |
| Rate for Payer: Aetna American Axle |
$76.10
|
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.10
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$81.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$105.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.52
|
| Rate for Payer: PHP Commercial |
$99.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.96
|
| Rate for Payer: Priority Health SBD |
$73.76
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.81
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 55111-262-79
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.86
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.12
|
|
|
Service Code
|
NDC 50268-615-13
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$214.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.75
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.38
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UMR Bronson Commercial |
$109.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$206.79
|
|
|
Service Code
|
NDC 62756-751-64
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.11 |
| Rate for Payer: Aetna American Axle |
$134.41
|
| Rate for Payer: Aetna Commercial |
$175.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.41
|
| Rate for Payer: Cash Price |
$165.43
|
| Rate for Payer: Cofinity Commercial |
$144.75
|
| Rate for Payer: Cofinity Commercial |
$177.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.43
|
| Rate for Payer: Healthscope Commercial |
$186.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.77
|
| Rate for Payer: PHP Commercial |
$175.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.75
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.09
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 0002-4453-01
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$317.30
|
|
|
Service Code
|
NDC 68084-723-01
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.61 |
| Max. Negotiated Rate |
$285.57 |
| Rate for Payer: Aetna American Axle |
$206.24
|
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.24
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$222.11
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$269.70
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.11
|
| Rate for Payer: Priority Health SBD |
$199.90
|
| Rate for Payer: UMR Bronson Commercial |
$139.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.98
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 0904-6377-61
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna American Axle |
$171.08
|
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$223.72
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.24
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UMR Bronson Commercial |
$115.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.40
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 60505-3111-0
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$245.69
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.34
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
