|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$88.07
|
|
|
Service Code
|
NDC 66993068030
|
| 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 Advantage |
$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 Commercial |
$74.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.05
|
| Rate for Payer: PHP Commercial |
$74.86
|
| 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 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 49884032052
|
| 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 Advantage |
$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 Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.26
|
| 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
|
OP
|
$3.83
|
|
|
Service Code
|
NDC 49884032052
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$3.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.87
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.49
|
| Rate for Payer: UHC Core |
$2.00
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.12
|
|
|
Service Code
|
NDC 50268061513
|
| 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 Advantage |
$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 Commercial |
$211.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.84
|
| Rate for Payer: PHP Commercial |
$211.75
|
| 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
|
OP
|
$114.63
|
|
|
Service Code
|
NDC 49884032055
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna Medicare |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$91.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.97
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.51
|
| Rate for Payer: UHC Core |
$59.72
|
| Rate for Payer: UHC Exchange |
$45.05
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 00002445301
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: BCBS Complete |
$23.03
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$46.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.42
|
| Rate for Payer: UHC Core |
$29.99
|
| Rate for Payer: UHC Exchange |
$22.63
|
| Rate for Payer: UMR Bronson Commercial |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$8.31
|
|
|
Service Code
|
NDC 50268061511
|
| 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 Advantage |
$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 Commercial |
$7.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.23
|
| Rate for Payer: PHP Commercial |
$7.06
|
| 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
|
OP
|
$117.08
|
|
|
Service Code
|
NDC 00378551093
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$105.37 |
| Rate for Payer: Aetna American Axle |
$76.10
|
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.10
|
| Rate for Payer: BCBS Complete |
$46.83
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cofinity Advantage |
$81.96
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$105.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.81
|
| Rate for Payer: PHP Commercial |
$99.52
|
| Rate for Payer: Priority Health SBD |
$73.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.10
|
| Rate for Payer: UHC Core |
$61.00
|
| Rate for Payer: UHC Exchange |
$46.01
|
| Rate for Payer: UMR Bronson Commercial |
$43.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.81
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$114.63
|
|
|
Service Code
|
NDC 60505327503
|
| 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 Advantage |
$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 Commercial |
$97.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.97
|
| Rate for Payer: PHP Commercial |
$97.44
|
| 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
|
OP
|
$114.63
|
|
|
Service Code
|
NDC 60505327503
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna Medicare |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$91.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.97
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.51
|
| Rate for Payer: UHC Core |
$59.72
|
| Rate for Payer: UHC Exchange |
$45.05
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$65.27
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare |
$32.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: BCBS Complete |
$26.11
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Advantage |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$56.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.95
|
| Rate for Payer: PHP Commercial |
$55.48
|
| Rate for Payer: Priority Health SBD |
$41.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.43
|
| Rate for Payer: UHC Core |
$34.01
|
| Rate for Payer: UHC Exchange |
$25.65
|
| Rate for Payer: UMR Bronson Commercial |
$24.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.95
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Advantage |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.79
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: Priority Health SBD |
$4.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.02
|
| Rate for Payer: UHC Core |
$4.02
|
| Rate for Payer: UHC Exchange |
$3.03
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 00002445301
|
| 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 Advantage |
$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 Commercial |
$48.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.18
|
| Rate for Payer: PHP Commercial |
$48.93
|
| 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
|
$114.63
|
|
|
Service Code
|
NDC 49884032055
|
| 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 Advantage |
$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 Commercial |
$97.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.97
|
| Rate for Payer: PHP Commercial |
$97.44
|
| 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
|
$65.27
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna American Axle |
$42.43
|
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.43
|
| Rate for Payer: Cash Price |
$52.22
|
| Rate for Payer: Cofinity Advantage |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$56.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.22
|
| Rate for Payer: Healthscope Commercial |
$58.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.95
|
| Rate for Payer: PHP Commercial |
$55.48
|
| Rate for Payer: Priority Health SBD |
$41.12
|
| Rate for Payer: UMR Bronson Commercial |
$28.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.95
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$249.12
|
|
|
Service Code
|
NDC 50268061513
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna Medicare |
$124.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: BCBS Complete |
$99.65
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$199.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.84
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.93
|
| Rate for Payer: UHC Core |
$129.79
|
| Rate for Payer: UHC Exchange |
$97.90
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$206.79
|
|
|
Service Code
|
NDC 62756075164
|
| 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 Advantage |
$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 Commercial |
$175.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.09
|
| Rate for Payer: PHP Commercial |
$175.77
|
| 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
|
OP
|
$8.31
|
|
|
Service Code
|
NDC 50268061511
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.48 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.23
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.40
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: UHC Exchange |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.23
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Advantage |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.79
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: Priority Health SBD |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$206.79
|
|
|
Service Code
|
NDC 62756075164
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$186.11 |
| Rate for Payer: Aetna American Axle |
$134.41
|
| Rate for Payer: Aetna Commercial |
$175.77
|
| Rate for Payer: Aetna Medicare |
$103.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.41
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: Cash Price |
$165.43
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$165.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.09
|
| Rate for Payer: PHP Commercial |
$175.77
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.41
|
| Rate for Payer: UHC Core |
$107.74
|
| Rate for Payer: UHC Exchange |
$81.27
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.09
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$117.08
|
|
|
Service Code
|
NDC 00378551093
|
| 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 Advantage |
$81.96
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$105.37
|
| Rate for Payer: 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 Commercial |
$99.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.81
|
| Rate for Payer: PHP Commercial |
$99.52
|
| 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 TABLET
|
Facility
|
IP
|
$329.65
|
|
|
Service Code
|
NDC 68084072301
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$296.69 |
| Rate for Payer: Aetna American Axle |
$214.27
|
| Rate for Payer: Aetna Commercial |
$280.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.27
|
| Rate for Payer: Cash Price |
$263.72
|
| Rate for Payer: Cofinity Advantage |
$230.75
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.72
|
| Rate for Payer: Healthscope Commercial |
$296.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.24
|
| Rate for Payer: PHP Commercial |
$280.20
|
| Rate for Payer: Priority Health SBD |
$207.68
|
| Rate for Payer: UMR Bronson Commercial |
$145.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.24
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 68084072311
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Advantage |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.15
|
| Rate for Payer: UHC Core |
$1.72
|
| Rate for Payer: UHC Exchange |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$168.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Advantage |
$235.24
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$235.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health SBD |
$211.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.43
|
| Rate for Payer: UHC Core |
$175.08
|
| Rate for Payer: UHC Exchange |
$132.07
|
| Rate for Payer: UMR Bronson Commercial |
$124.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Advantage |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.57
|
| Rate for Payer: UHC Core |
$159.17
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
