|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$85.03
|
|
|
Service Code
|
NDC 00002445401
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.41 |
| Max. Negotiated Rate |
$76.53 |
| Rate for Payer: Aetna American Axle |
$55.27
|
| Rate for Payer: Aetna Commercial |
$72.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.27
|
| Rate for Payer: Cash Price |
$68.02
|
| Rate for Payer: Cofinity Advantage |
$59.52
|
| Rate for Payer: Cofinity Commercial |
$73.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.02
|
| Rate for Payer: Healthscope Commercial |
$76.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.77
|
| Rate for Payer: PHP Commercial |
$72.28
|
| Rate for Payer: Priority Health SBD |
$53.57
|
| Rate for Payer: UMR Bronson Commercial |
$37.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.77
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$5.65
|
|
|
Service Code
|
NDC 59746030712
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna American Axle |
$3.67
|
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna Medicare |
$2.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.67
|
| Rate for Payer: BCBS Complete |
$2.26
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cofinity Advantage |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.24
|
| Rate for Payer: PHP Commercial |
$4.80
|
| Rate for Payer: Priority Health SBD |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.67
|
| Rate for Payer: UHC Core |
$2.94
|
| Rate for Payer: UHC Exchange |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.24
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$262.30
|
|
|
Service Code
|
NDC 55111026381
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.41 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna American Axle |
$170.50
|
| Rate for Payer: Aetna Commercial |
$222.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.50
|
| Rate for Payer: Cash Price |
$209.84
|
| Rate for Payer: Cofinity Advantage |
$183.61
|
| Rate for Payer: Cofinity Commercial |
$225.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.84
|
| Rate for Payer: Healthscope Commercial |
$236.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.72
|
| Rate for Payer: PHP Commercial |
$222.96
|
| Rate for Payer: Priority Health SBD |
$165.25
|
| Rate for Payer: UMR Bronson Commercial |
$115.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.72
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$5.62
|
|
|
Service Code
|
NDC 49884032152
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$5.06 |
| Rate for Payer: Aetna American Axle |
$3.65
|
| Rate for Payer: Aetna Commercial |
$4.78
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: BCBS Complete |
$2.25
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cofinity Advantage |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$4.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$5.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.78
|
| Rate for Payer: Priority Health SBD |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$2.93
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UMR Bronson Commercial |
$2.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.21
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$5.65
|
|
|
Service Code
|
NDC 59746030712
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Aetna American Axle |
$3.67
|
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.67
|
| Rate for Payer: Cash Price |
$4.52
|
| Rate for Payer: Cofinity Advantage |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.52
|
| Rate for Payer: Healthscope Commercial |
$5.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.24
|
| Rate for Payer: PHP Commercial |
$4.80
|
| Rate for Payer: Priority Health SBD |
$3.56
|
| Rate for Payer: UMR Bronson Commercial |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.24
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$53.89
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna American Axle |
$35.03
|
| Rate for Payer: Aetna American Axle |
$42.12
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: BCBS Complete |
$25.92
|
| Rate for Payer: BCBS Complete |
$21.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cofinity Advantage |
$37.72
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.42
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Core |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UMR Bronson Commercial |
$19.94
|
| Rate for Payer: UMR Bronson Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.60
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$53.89
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna American Axle |
$35.03
|
| Rate for Payer: Aetna American Axle |
$42.12
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Advantage |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: UMR Bronson Commercial |
$23.71
|
| Rate for Payer: UMR Bronson Commercial |
$28.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.60
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$64.80
|
|
|
Service Code
|
NDC 00781315972
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.51 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna American Axle |
$42.12
|
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: UMR Bronson Commercial |
$28.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.60
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$64.80
|
|
|
Service Code
|
NDC 00781315972
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna American Axle |
$42.12
|
| Rate for Payer: Aetna Commercial |
$55.08
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.12
|
| Rate for Payer: BCBS Complete |
$25.92
|
| Rate for Payer: Cash Price |
$51.84
|
| Rate for Payer: Cofinity Advantage |
$45.36
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.84
|
| Rate for Payer: Healthscope Commercial |
$58.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.60
|
| Rate for Payer: PHP Commercial |
$55.08
|
| Rate for Payer: Priority Health SBD |
$40.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.12
|
| Rate for Payer: UHC Core |
$33.76
|
| Rate for Payer: UHC Exchange |
$25.47
|
| Rate for Payer: UMR Bronson Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.60
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$163.36
|
|
|
Service Code
|
NDC 00517095501
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.44 |
| Max. Negotiated Rate |
$147.02 |
| Rate for Payer: Aetna American Axle |
$106.18
|
| Rate for Payer: Aetna Commercial |
$138.86
|
| Rate for Payer: Aetna Medicare |
$81.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.18
|
| Rate for Payer: BCBS Complete |
$65.34
|
| Rate for Payer: Cash Price |
$130.69
|
| Rate for Payer: Cofinity Advantage |
$114.35
|
| Rate for Payer: Cofinity Commercial |
$140.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.69
|
| Rate for Payer: Healthscope Commercial |
$147.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.52
|
| Rate for Payer: PHP Commercial |
$138.86
|
| Rate for Payer: Priority Health SBD |
$102.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.18
|
| Rate for Payer: UHC Core |
$85.11
|
| Rate for Payer: UHC Exchange |
$64.20
|
| Rate for Payer: UMR Bronson Commercial |
$60.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.52
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
NDC 00002759701
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$163.36
|
|
|
Service Code
|
NDC 00517095501
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.88 |
| Max. Negotiated Rate |
$147.02 |
| Rate for Payer: Aetna American Axle |
$106.18
|
| Rate for Payer: Aetna Commercial |
$138.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.18
|
| Rate for Payer: Cash Price |
$130.69
|
| Rate for Payer: Cofinity Advantage |
$114.35
|
| Rate for Payer: Cofinity Commercial |
$140.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.69
|
| Rate for Payer: Healthscope Commercial |
$147.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.52
|
| Rate for Payer: PHP Commercial |
$138.86
|
| Rate for Payer: Priority Health SBD |
$102.92
|
| Rate for Payer: UMR Bronson Commercial |
$71.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.52
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53.89
|
|
|
Service Code
|
NDC 31722030801
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna American Axle |
$35.03
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cofinity Advantage |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.42
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: UMR Bronson Commercial |
$23.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.89
|
|
|
Service Code
|
NDC 31722030801
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.94 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna American Axle |
$35.03
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Medicare |
$26.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: BCBS Complete |
$21.56
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cofinity Advantage |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.42
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.03
|
| Rate for Payer: UHC Core |
$28.08
|
| Rate for Payer: UHC Exchange |
$21.18
|
| Rate for Payer: UMR Bronson Commercial |
$19.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
NDC 00002759701
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Advantage |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$166.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.20
|
| Rate for Payer: UHC Core |
$108.37
|
| Rate for Payer: UHC Exchange |
$81.74
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00904637661
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 60505311300
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 60505311300
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.06
|
| Rate for Payer: UHC Core |
$225.28
|
| Rate for Payer: UHC Exchange |
$169.93
|
| Rate for Payer: UMR Bronson Commercial |
$159.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00904637661
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Advantage |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$204.47
|
| Rate for Payer: UHC Exchange |
$154.23
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$248.26
|
|
|
Service Code
|
NDC 49884032255
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.86 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Advantage |
$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 |
$186.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.19
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.37
|
| Rate for Payer: UHC Core |
$129.34
|
| Rate for Payer: UHC Exchange |
$97.57
|
| Rate for Payer: UMR Bronson Commercial |
$91.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 59746030832
|
| 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 Advantage |
$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 |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.19
|
| Rate for Payer: PHP Commercial |
$211.02
|
| 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 |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 49884032255
|
| 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 Advantage |
$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 |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.19
|
| Rate for Payer: PHP Commercial |
$211.02
|
| 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 |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$386.84
|
|
|
Service Code
|
NDC 55111026481
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.13 |
| Max. Negotiated Rate |
$348.16 |
| Rate for Payer: Aetna American Axle |
$251.45
|
| Rate for Payer: Aetna Commercial |
$328.81
|
| Rate for Payer: Aetna Medicare |
$193.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.45
|
| Rate for Payer: BCBS Complete |
$154.74
|
| Rate for Payer: Cash Price |
$309.47
|
| Rate for Payer: Cofinity Advantage |
$270.79
|
| Rate for Payer: Cofinity Commercial |
$332.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.47
|
| Rate for Payer: Healthscope Commercial |
$348.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.13
|
| Rate for Payer: PHP Commercial |
$328.81
|
| Rate for Payer: Priority Health SBD |
$243.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.45
|
| Rate for Payer: UHC Core |
$201.54
|
| Rate for Payer: UHC Exchange |
$152.03
|
| Rate for Payer: UMR Bronson Commercial |
$143.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.13
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$386.84
|
|
|
Service Code
|
NDC 55111026481
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$348.16 |
| Rate for Payer: Aetna American Axle |
$251.45
|
| Rate for Payer: Aetna Commercial |
$328.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.45
|
| Rate for Payer: Cash Price |
$309.47
|
| Rate for Payer: Cofinity Advantage |
$270.79
|
| Rate for Payer: Cofinity Commercial |
$332.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.47
|
| Rate for Payer: Healthscope Commercial |
$348.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.13
|
| Rate for Payer: PHP Commercial |
$328.81
|
| Rate for Payer: Priority Health SBD |
$243.71
|
| Rate for Payer: UMR Bronson Commercial |
$170.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.13
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$125.86
|
|
|
Service Code
|
NDC 00002445501
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: Aetna American Axle |
$81.81
|
| Rate for Payer: Aetna Commercial |
$106.98
|
| Rate for Payer: Aetna Medicare |
$62.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.81
|
| Rate for Payer: BCBS Complete |
$50.34
|
| Rate for Payer: Cash Price |
$100.69
|
| Rate for Payer: Cofinity Advantage |
$88.10
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| 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 |
$94.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.39
|
| Rate for Payer: PHP Commercial |
$106.98
|
| Rate for Payer: Priority Health SBD |
$79.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.81
|
| Rate for Payer: UHC Core |
$65.57
|
| Rate for Payer: UHC Exchange |
$49.46
|
| Rate for Payer: UMR Bronson Commercial |
$46.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.39
|
|
