|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.86 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna American Axle |
$218.43
|
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.43
|
| 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: 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: UMR Bronson Commercial |
$147.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| 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: 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: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$329.65
|
|
|
Service Code
|
NDC 68084072301
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$296.69 |
| Rate for Payer: Aetna American Axle |
$214.27
|
| Rate for Payer: Aetna Commercial |
$280.20
|
| Rate for Payer: Aetna Medicare |
$164.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.27
|
| Rate for Payer: BCBS Complete |
$131.86
|
| 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: MI Amish Medical Board Commercial |
$263.72
|
| 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: UHC All Payor (Choice/PPO) |
$214.27
|
| Rate for Payer: UHC Core |
$171.75
|
| Rate for Payer: UHC Exchange |
$129.55
|
| Rate for Payer: UMR Bronson Commercial |
$121.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.24
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 68084072311
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| 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: 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: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$42.67
|
|
|
Service Code
|
NDC 70069000701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna American Axle |
$27.74
|
| Rate for Payer: Aetna Commercial |
$36.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Advantage |
$29.87
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.00
|
| Rate for Payer: PHP Commercial |
$36.27
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: UMR Bronson Commercial |
$18.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$22.73
|
|
|
Service Code
|
NDC 70069001701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Aetna American Axle |
$14.77
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: BCBS Complete |
$9.09
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: PHP Commercial |
$19.32
|
| Rate for Payer: Priority Health SBD |
$14.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.77
|
| Rate for Payer: UHC Core |
$11.84
|
| Rate for Payer: UHC Exchange |
$8.93
|
| Rate for Payer: UMR Bronson Commercial |
$8.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.05
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$22.58
|
|
|
Service Code
|
NDC 70512052005
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$20.32 |
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna Commercial |
$19.19
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.19
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.68
|
| Rate for Payer: UHC Core |
$11.76
|
| Rate for Payer: UHC Exchange |
$8.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$42.67
|
|
|
Service Code
|
NDC 70069000701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna American Axle |
$27.74
|
| Rate for Payer: Aetna Commercial |
$36.27
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: BCBS Complete |
$17.07
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Advantage |
$29.87
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.00
|
| Rate for Payer: PHP Commercial |
$36.27
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.74
|
| Rate for Payer: UHC Core |
$22.23
|
| Rate for Payer: UHC Exchange |
$16.77
|
| Rate for Payer: UMR Bronson Commercial |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$22.73
|
|
|
Service Code
|
NDC 70069001701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Aetna American Axle |
$14.77
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.77
|
| Rate for Payer: Cash Price |
$18.18
|
| Rate for Payer: Cofinity Advantage |
$15.91
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.18
|
| Rate for Payer: Healthscope Commercial |
$20.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: PHP Commercial |
$19.32
|
| Rate for Payer: Priority Health SBD |
$14.32
|
| Rate for Payer: UMR Bronson Commercial |
$10.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.05
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$22.58
|
|
|
Service Code
|
NDC 70512052005
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.94 |
| Max. Negotiated Rate |
$20.32 |
| Rate for Payer: Aetna American Axle |
$14.68
|
| Rate for Payer: Aetna Commercial |
$19.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.68
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.19
|
| Rate for Payer: Priority Health SBD |
$14.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna American Axle |
$3,231.83
|
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,480.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,729.03
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,839.65
|
| Rate for Payer: VA VA |
$41.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,729.03
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,187.70 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna American Axle |
$3,231.83
|
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,480.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,729.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
| Rate for Payer: UMR Bronson Commercial |
$2,187.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,729.03
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna American Axle |
$3,231.83
|
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,480.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,729.03
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,839.65
|
| Rate for Payer: VA VA |
$41.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,729.03
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,972.04
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,187.70 |
| Max. Negotiated Rate |
$4,474.84 |
| Rate for Payer: Aetna American Axle |
$3,231.83
|
| Rate for Payer: Aetna Commercial |
$4,226.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,231.83
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Advantage |
$3,480.43
|
| Rate for Payer: Cofinity Commercial |
$4,275.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Healthscope Commercial |
$4,474.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,480.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,729.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.03
|
| Rate for Payer: PHP Commercial |
$4,226.23
|
| Rate for Payer: Priority Health SBD |
$3,132.39
|
| Rate for Payer: UMR Bronson Commercial |
$2,187.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,729.03
|
|
|
OMALIZUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$8,079.58
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$7,271.62 |
| Rate for Payer: Aetna American Axle |
$5,251.73
|
| Rate for Payer: Aetna Commercial |
$6,867.64
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,251.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$6,463.66
|
| Rate for Payer: Cash Price |
$6,463.66
|
| Rate for Payer: Cofinity Advantage |
$5,655.71
|
| Rate for Payer: Cofinity Commercial |
$6,948.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,463.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$7,271.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,655.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,059.69
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,867.64
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,059.69
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$6,867.64
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$5,090.14
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$2,989.44
|
| Rate for Payer: VA VA |
$41.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,059.69
|
|
|
OMALIZUMAB 300 MG/2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$8,079.58
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,555.02 |
| Max. Negotiated Rate |
$7,271.62 |
| Rate for Payer: Aetna American Axle |
$5,251.73
|
| Rate for Payer: Aetna Commercial |
$6,867.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,251.73
|
| Rate for Payer: Cash Price |
$6,463.66
|
| Rate for Payer: Cofinity Advantage |
$5,655.71
|
| Rate for Payer: Cofinity Commercial |
$6,948.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,463.66
|
| Rate for Payer: Healthscope Commercial |
$7,271.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,655.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,059.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,867.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,059.69
|
| Rate for Payer: PHP Commercial |
$6,867.64
|
| Rate for Payer: Priority Health SBD |
$5,090.14
|
| Rate for Payer: UMR Bronson Commercial |
$3,555.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,059.69
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$2,265.80
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$996.95 |
| Max. Negotiated Rate |
$2,039.22 |
| Rate for Payer: Aetna American Axle |
$1,472.77
|
| Rate for Payer: Aetna Commercial |
$1,925.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cofinity Advantage |
$1,586.06
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.64
|
| Rate for Payer: Healthscope Commercial |
$2,039.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,586.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,699.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.35
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
| Rate for Payer: UMR Bronson Commercial |
$996.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,699.35
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$2,265.80
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$2,039.22 |
| Rate for Payer: Aetna American Axle |
$1,472.77
|
| Rate for Payer: Aetna American Axle |
$1,615.91
|
| Rate for Payer: Aetna Commercial |
$1,925.93
|
| Rate for Payer: Aetna Commercial |
$2,113.12
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,615.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCBS Trust/PPO |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: BCN Commercial |
$147.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$1,988.82
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cash Price |
$1,988.82
|
| Rate for Payer: Cofinity Advantage |
$1,740.21
|
| Rate for Payer: Cofinity Advantage |
$1,586.06
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Cofinity Commercial |
$2,137.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,988.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$2,039.22
|
| Rate for Payer: Healthscope Commercial |
$2,237.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,586.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,740.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,864.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,699.35
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$43.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,113.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Nomi Health Commercial |
$125.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,864.52
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: PHP Commercial |
$2,113.12
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$140.64
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health SBD |
$1,566.19
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Priority Health Tiered Network |
$112.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Core |
$75.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Exchange |
$75.08
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$838.35
|
| Rate for Payer: UMR Bronson Commercial |
$919.83
|
| Rate for Payer: VA VA |
$41.82
|
| Rate for Payer: VA VA |
$41.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,699.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,864.52
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$547.08
|
|
|
Service Code
|
NDC 42806055212
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$492.37 |
| Rate for Payer: Aetna American Axle |
$355.60
|
| Rate for Payer: Aetna Commercial |
$465.02
|
| Rate for Payer: Aetna Medicare |
$273.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: BCBS Complete |
$218.83
|
| Rate for Payer: Cash Price |
$437.66
|
| Rate for Payer: Cofinity Advantage |
$382.96
|
| Rate for Payer: Cofinity Commercial |
$470.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.66
|
| Rate for Payer: Healthscope Commercial |
$492.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$410.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$437.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.31
|
| Rate for Payer: PHP Commercial |
$465.02
|
| Rate for Payer: Priority Health SBD |
$344.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.60
|
| Rate for Payer: UHC Core |
$285.03
|
| Rate for Payer: UHC Exchange |
$215.00
|
| Rate for Payer: UMR Bronson Commercial |
$202.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$410.31
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$434.88
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna American Axle |
$282.67
|
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: Aetna Medicare |
$217.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.67
|
| Rate for Payer: BCBS Complete |
$173.95
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cofinity Advantage |
$304.42
|
| Rate for Payer: Cofinity Commercial |
$374.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.90
|
| Rate for Payer: Healthscope Commercial |
$391.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.16
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health SBD |
$273.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.67
|
| Rate for Payer: UHC Core |
$226.57
|
| Rate for Payer: UHC Exchange |
$170.91
|
| Rate for Payer: UMR Bronson Commercial |
$160.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.16
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$547.08
|
|
|
Service Code
|
NDC 42806055212
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$492.37 |
| Rate for Payer: Aetna American Axle |
$355.60
|
| Rate for Payer: Aetna Commercial |
$465.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: Cash Price |
$437.66
|
| Rate for Payer: Cofinity Advantage |
$382.96
|
| Rate for Payer: Cofinity Commercial |
$470.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.66
|
| Rate for Payer: Healthscope Commercial |
$492.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$410.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.31
|
| Rate for Payer: PHP Commercial |
$465.02
|
| Rate for Payer: Priority Health SBD |
$344.66
|
| Rate for Payer: UMR Bronson Commercial |
$240.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$410.31
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$434.88
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.35 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna American Axle |
$282.67
|
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.67
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cofinity Advantage |
$304.42
|
| Rate for Payer: Cofinity Commercial |
$374.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.90
|
| Rate for Payer: Healthscope Commercial |
$391.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.16
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health SBD |
$273.97
|
| Rate for Payer: UMR Bronson Commercial |
$191.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.16
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$231.42
|
|
|
Service Code
|
NDC 70756042322
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$208.28 |
| Rate for Payer: Aetna American Axle |
$150.42
|
| Rate for Payer: Aetna Commercial |
$196.71
|
| Rate for Payer: Aetna Medicare |
$115.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.42
|
| Rate for Payer: BCBS Complete |
$92.57
|
| Rate for Payer: Cash Price |
$185.14
|
| Rate for Payer: Cofinity Advantage |
$161.99
|
| Rate for Payer: Cofinity Commercial |
$199.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.14
|
| Rate for Payer: Healthscope Commercial |
$208.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.56
|
| Rate for Payer: PHP Commercial |
$196.71
|
| Rate for Payer: Priority Health SBD |
$145.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.42
|
| Rate for Payer: UHC Core |
$120.57
|
| Rate for Payer: UHC Exchange |
$90.95
|
| Rate for Payer: UMR Bronson Commercial |
$85.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.56
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$231.42
|
|
|
Service Code
|
NDC 70756042322
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.82 |
| Max. Negotiated Rate |
$208.28 |
| Rate for Payer: Aetna American Axle |
$150.42
|
| Rate for Payer: Aetna Commercial |
$196.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.42
|
| Rate for Payer: Cash Price |
$185.14
|
| Rate for Payer: Cofinity Advantage |
$161.99
|
| Rate for Payer: Cofinity Commercial |
$199.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.14
|
| Rate for Payer: Healthscope Commercial |
$208.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.56
|
| Rate for Payer: PHP Commercial |
$196.71
|
| Rate for Payer: Priority Health SBD |
$145.79
|
| Rate for Payer: UMR Bronson Commercial |
$101.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.56
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$100.61
|
|
|
Service Code
|
NDC 67544051030
|
| Hospital Charge Code |
27694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$90.55 |
| Rate for Payer: Aetna American Axle |
$65.40
|
| Rate for Payer: Aetna Commercial |
$85.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.40
|
| Rate for Payer: Cash Price |
$80.49
|
| Rate for Payer: Cofinity Advantage |
$70.43
|
| Rate for Payer: Cofinity Commercial |
$86.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.49
|
| Rate for Payer: Healthscope Commercial |
$90.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.46
|
| Rate for Payer: PHP Commercial |
$85.52
|
| Rate for Payer: Priority Health SBD |
$63.38
|
| Rate for Payer: UMR Bronson Commercial |
$44.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.46
|
|
