|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$100.61
|
|
|
Service Code
|
NDC 67544051030
|
| Hospital Charge Code |
27694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$90.55 |
| Rate for Payer: Aetna American Axle |
$65.40
|
| Rate for Payer: Aetna Commercial |
$85.52
|
| Rate for Payer: Aetna Medicare |
$50.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.40
|
| Rate for Payer: BCBS Complete |
$40.24
|
| 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: MI Amish Medical Board Commercial |
$80.49
|
| 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: UHC All Payor (Choice/PPO) |
$65.40
|
| Rate for Payer: UHC Core |
$52.42
|
| Rate for Payer: UHC Exchange |
$39.54
|
| Rate for Payer: UMR Bronson Commercial |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.46
|
|
|
OMEPRAZOLE 2 MG-SODIUM BICARBONATE 84 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$809.14
|
|
|
Service Code
|
NDC 65628027203
|
| Hospital Charge Code |
203260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.02 |
| Max. Negotiated Rate |
$728.23 |
| Rate for Payer: Aetna American Axle |
$525.94
|
| Rate for Payer: Aetna Commercial |
$687.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.94
|
| Rate for Payer: Cash Price |
$647.31
|
| Rate for Payer: Cofinity Advantage |
$566.40
|
| Rate for Payer: Cofinity Commercial |
$695.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.31
|
| Rate for Payer: Healthscope Commercial |
$728.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.86
|
| Rate for Payer: PHP Commercial |
$687.77
|
| Rate for Payer: Priority Health SBD |
$509.76
|
| Rate for Payer: UMR Bronson Commercial |
$356.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.86
|
|
|
OMEPRAZOLE 2 MG-SODIUM BICARBONATE 84 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$809.14
|
|
|
Service Code
|
NDC 65628027203
|
| Hospital Charge Code |
203260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.38 |
| Max. Negotiated Rate |
$728.23 |
| Rate for Payer: Aetna American Axle |
$525.94
|
| Rate for Payer: Aetna Commercial |
$687.77
|
| Rate for Payer: Aetna Medicare |
$404.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.94
|
| Rate for Payer: BCBS Complete |
$323.66
|
| Rate for Payer: Cash Price |
$647.31
|
| Rate for Payer: Cofinity Advantage |
$566.40
|
| Rate for Payer: Cofinity Commercial |
$695.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.31
|
| Rate for Payer: Healthscope Commercial |
$728.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$606.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$647.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$687.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$606.86
|
| Rate for Payer: PHP Commercial |
$687.77
|
| Rate for Payer: Priority Health SBD |
$509.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.94
|
| Rate for Payer: UHC Core |
$421.56
|
| Rate for Payer: UHC Exchange |
$317.99
|
| Rate for Payer: UMR Bronson Commercial |
$299.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$606.86
|
|
|
ONABOTULINUMTOXINA 100 UNIT/3 ML INJECTION CUSTOM
|
Facility
|
IP
|
$1,923.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
180907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.21 |
| Max. Negotiated Rate |
$1,730.88 |
| Rate for Payer: Aetna American Axle |
$1,250.08
|
| Rate for Payer: Aetna Commercial |
$1,634.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.08
|
| Rate for Payer: Cash Price |
$1,538.56
|
| Rate for Payer: Cofinity Advantage |
$1,346.24
|
| Rate for Payer: Cofinity Commercial |
$1,653.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.56
|
| Rate for Payer: Healthscope Commercial |
$1,730.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,346.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,442.40
|
| Rate for Payer: PHP Commercial |
$1,634.72
|
| Rate for Payer: Priority Health SBD |
$1,211.62
|
| Rate for Payer: UMR Bronson Commercial |
$846.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT/3 ML INJECTION CUSTOM
|
Facility
|
OP
|
$1,923.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
180907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$1,730.88 |
| Rate for Payer: Aetna American Axle |
$1,250.08
|
| Rate for Payer: Aetna Commercial |
$1,634.72
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$1,538.56
|
| Rate for Payer: Cash Price |
$1,538.56
|
| Rate for Payer: Cofinity Advantage |
$1,346.24
|
| Rate for Payer: Cofinity Commercial |
$1,653.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$1,730.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,346.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.40
|
| Rate for Payer: Mclaren Medicaid |
$6.51
|
| Rate for Payer: Mclaren Medicare |
$6.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.72
|
| Rate for Payer: Nomi Health Commercial |
$19.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,442.40
|
| Rate for Payer: PACE Medicare |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$1,634.72
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.50
|
| Rate for Payer: Priority Health Medicare |
$6.51
|
| Rate for Payer: Priority Health SBD |
$1,211.62
|
| Rate for Payer: Priority Health Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.51
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UHC Medicaid |
$3.40
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: UMR Bronson Commercial |
$711.58
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,083.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$916.61 |
| Max. Negotiated Rate |
$1,874.88 |
| Rate for Payer: Aetna American Axle |
$1,354.08
|
| Rate for Payer: Aetna Commercial |
$1,770.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,354.08
|
| Rate for Payer: Cash Price |
$1,666.56
|
| Rate for Payer: Cofinity Advantage |
$1,458.24
|
| Rate for Payer: Cofinity Commercial |
$1,791.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,666.56
|
| Rate for Payer: Healthscope Commercial |
$1,874.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,458.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,562.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,770.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,562.40
|
| Rate for Payer: PHP Commercial |
$1,770.72
|
| Rate for Payer: Priority Health SBD |
$1,312.42
|
| Rate for Payer: UMR Bronson Commercial |
$916.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,562.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,083.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$1,874.88 |
| Rate for Payer: Aetna American Axle |
$1,354.08
|
| Rate for Payer: Aetna Commercial |
$1,770.72
|
| Rate for Payer: Aetna Medicare |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,354.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.14
|
| Rate for Payer: BCBS Complete |
$3.58
|
| Rate for Payer: BCBS MAPPO |
$6.51
|
| Rate for Payer: BCBS Trust/PPO |
$21.10
|
| Rate for Payer: BCN Commercial |
$21.10
|
| Rate for Payer: BCN Medicare Advantage |
$6.51
|
| Rate for Payer: Cash Price |
$1,666.56
|
| Rate for Payer: Cash Price |
$1,666.56
|
| Rate for Payer: Cofinity Advantage |
$1,458.24
|
| Rate for Payer: Cofinity Commercial |
$1,791.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,666.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.51
|
| Rate for Payer: Healthscope Commercial |
$1,874.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,458.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,562.40
|
| Rate for Payer: Mclaren Medicaid |
$6.51
|
| Rate for Payer: Mclaren Medicare |
$6.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.84
|
| Rate for Payer: Meridian Medicaid |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,770.72
|
| Rate for Payer: Nomi Health Commercial |
$19.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,562.40
|
| Rate for Payer: PACE Medicare |
$6.18
|
| Rate for Payer: PACE SWMI |
$6.51
|
| Rate for Payer: PHP Commercial |
$1,770.72
|
| Rate for Payer: PHP Medicare Advantage |
$6.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.50
|
| Rate for Payer: Priority Health Medicare |
$6.51
|
| Rate for Payer: Priority Health SBD |
$1,312.42
|
| Rate for Payer: Priority Health Tiered Network |
$16.40
|
| Rate for Payer: Railroad Medicare Medicare |
$6.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Core |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.51
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UHC Medicaid |
$3.40
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: UMR Bronson Commercial |
$770.78
|
| Rate for Payer: VA VA |
$6.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,562.40
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$81.94
|
|
|
Service Code
|
NDC 00378773293
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna Medicare |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: BCBS Complete |
$32.78
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.26
|
| Rate for Payer: UHC Core |
$42.69
|
| Rate for Payer: UHC Exchange |
$32.20
|
| Rate for Payer: UMR Bronson Commercial |
$30.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$139.59
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna American Axle |
$90.73
|
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: Aetna Medicare |
$69.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.73
|
| Rate for Payer: BCBS Complete |
$55.84
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Advantage |
$97.71
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Healthscope Commercial |
$125.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: PHP Commercial |
$118.65
|
| Rate for Payer: Priority Health SBD |
$87.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.73
|
| Rate for Payer: UHC Core |
$72.73
|
| Rate for Payer: UHC Exchange |
$54.86
|
| Rate for Payer: UMR Bronson Commercial |
$51.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.69
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$139.59
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.42 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna American Axle |
$90.73
|
| Rate for Payer: Aetna Commercial |
$118.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.73
|
| Rate for Payer: Cash Price |
$111.67
|
| Rate for Payer: Cofinity Advantage |
$97.71
|
| Rate for Payer: Cofinity Commercial |
$120.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.67
|
| Rate for Payer: Healthscope Commercial |
$125.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.69
|
| Rate for Payer: PHP Commercial |
$118.65
|
| Rate for Payer: Priority Health SBD |
$87.94
|
| Rate for Payer: UMR Bronson Commercial |
$61.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.69
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$81.94
|
|
|
Service Code
|
NDC 65862039010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna Medicare |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: BCBS Complete |
$32.78
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.26
|
| Rate for Payer: UHC Core |
$42.69
|
| Rate for Payer: UHC Exchange |
$32.20
|
| Rate for Payer: UMR Bronson Commercial |
$30.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 62756024064
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 00378773293
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UMR Bronson Commercial |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$81.94
|
|
|
Service Code
|
NDC 62756024064
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.32 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna Medicare |
$40.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: BCBS Complete |
$32.78
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Advantage |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.45
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.26
|
| Rate for Payer: UHC Core |
$42.69
|
| Rate for Payer: UHC Exchange |
$32.20
|
| Rate for Payer: UMR Bronson Commercial |
$30.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.45
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna American Axle |
$43.17
|
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: Aetna Medicare |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.17
|
| Rate for Payer: BCBS Complete |
$26.56
|
| Rate for Payer: Cash Price |
$53.13
|
| Rate for Payer: Cofinity Advantage |
$46.49
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.13
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.81
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: Priority Health SBD |
$41.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.17
|
| Rate for Payer: UHC Core |
$34.60
|
| Rate for Payer: UHC Exchange |
$26.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.81
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.19 |
| Rate for Payer: Aetna American Axle |
$3.03
|
| Rate for Payer: Aetna Commercial |
$3.96
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Advantage |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$4.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.73
|
| Rate for Payer: Healthscope Commercial |
$4.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.96
|
| Rate for Payer: Priority Health SBD |
$2.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.03
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: UHC Exchange |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.50
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 62756024060
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Advantage |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.43
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Aetna American Axle |
$107.90
|
| Rate for Payer: Aetna American Axle |
$68.58
|
| Rate for Payer: Aetna American Axle |
$83.20
|
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna American Axle |
$69.55
|
| Rate for Payer: Aetna American Axle |
$37.70
|
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Commercial |
$89.67
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna Commercial |
$90.95
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$52.75
|
| Rate for Payer: Aetna Medicare |
$29.00
|
| Rate for Payer: Aetna Medicare |
$83.00
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$42.20
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$84.40
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$84.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Advantage |
$105.00
|
| Rate for Payer: Cofinity Advantage |
$89.60
|
| Rate for Payer: Cofinity Advantage |
$74.90
|
| Rate for Payer: Cofinity Advantage |
$73.85
|
| Rate for Payer: Cofinity Advantage |
$116.20
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Advantage |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Cofinity Commercial |
$90.73
|
| Rate for Payer: Cofinity Commercial |
$92.02
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.40
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Healthscope Commercial |
$96.30
|
| Rate for Payer: Healthscope Commercial |
$94.95
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.12
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: PHP Commercial |
$89.67
|
| Rate for Payer: PHP Commercial |
$90.95
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$49.30
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$80.64
|
| Rate for Payer: Priority Health SBD |
$104.58
|
| Rate for Payer: Priority Health SBD |
$36.54
|
| Rate for Payer: Priority Health SBD |
$67.41
|
| Rate for Payer: Priority Health SBD |
$66.47
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$47.36
|
| Rate for Payer: UMR Bronson Commercial |
$55.50
|
| Rate for Payer: UMR Bronson Commercial |
$39.59
|
| Rate for Payer: UMR Bronson Commercial |
$39.03
|
| Rate for Payer: UMR Bronson Commercial |
$21.46
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: UMR Bronson Commercial |
$61.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$105.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.42 |
| Max. Negotiated Rate |
$94.95 |
| Rate for Payer: Aetna American Axle |
$68.58
|
| Rate for Payer: Aetna American Axle |
$83.20
|
| Rate for Payer: Aetna American Axle |
$97.50
|
| Rate for Payer: Aetna American Axle |
$37.70
|
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna American Axle |
$107.90
|
| Rate for Payer: Aetna American Axle |
$69.55
|
| Rate for Payer: Aetna Commercial |
$127.50
|
| Rate for Payer: Aetna Commercial |
$90.95
|
| Rate for Payer: Aetna Commercial |
$89.67
|
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Commercial |
$141.10
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.70
|
| Rate for Payer: Cash Price |
$84.40
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Advantage |
$73.85
|
| Rate for Payer: Cofinity Advantage |
$74.90
|
| Rate for Payer: Cofinity Advantage |
$105.00
|
| Rate for Payer: Cofinity Advantage |
$89.60
|
| Rate for Payer: Cofinity Advantage |
$116.20
|
| Rate for Payer: Cofinity Advantage |
$40.60
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Cofinity Commercial |
$49.88
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Commercial |
$90.73
|
| Rate for Payer: Cofinity Commercial |
$92.02
|
| Rate for Payer: Cofinity Commercial |
$142.76
|
| Rate for Payer: Cofinity Commercial |
$129.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.60
|
| Rate for Payer: Healthscope Commercial |
$52.20
|
| Rate for Payer: Healthscope Commercial |
$94.95
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Commercial |
$135.00
|
| Rate for Payer: Healthscope Commercial |
$96.30
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Healthscope Commercial |
$149.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: PHP Commercial |
$90.95
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$127.50
|
| Rate for Payer: PHP Commercial |
$49.30
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: PHP Commercial |
$89.67
|
| Rate for Payer: PHP Commercial |
$141.10
|
| Rate for Payer: Priority Health SBD |
$66.47
|
| Rate for Payer: Priority Health SBD |
$94.50
|
| Rate for Payer: Priority Health SBD |
$104.58
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: Priority Health SBD |
$36.54
|
| Rate for Payer: Priority Health SBD |
$67.41
|
| Rate for Payer: Priority Health SBD |
$80.64
|
| Rate for Payer: UMR Bronson Commercial |
$25.52
|
| Rate for Payer: UMR Bronson Commercial |
$46.42
|
| Rate for Payer: UMR Bronson Commercial |
$66.00
|
| Rate for Payer: UMR Bronson Commercial |
$47.08
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: UMR Bronson Commercial |
$56.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.50
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$116.38
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$104.74 |
| Rate for Payer: Aetna American Axle |
$75.65
|
| Rate for Payer: Aetna Commercial |
$98.92
|
| Rate for Payer: Aetna Medicare |
$58.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.65
|
| Rate for Payer: BCBS Complete |
$46.55
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Advantage |
$81.47
|
| Rate for Payer: Cofinity Commercial |
$100.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$104.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.28
|
| Rate for Payer: PHP Commercial |
$98.92
|
| Rate for Payer: Priority Health SBD |
$73.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.65
|
| Rate for Payer: UHC Core |
$60.63
|
| Rate for Payer: UHC Exchange |
$45.74
|
| Rate for Payer: UMR Bronson Commercial |
$43.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.28
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$220.88
|
|
|
Service Code
|
NDC 54838055550
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.73 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna American Axle |
$143.57
|
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna Medicare |
$110.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Advantage |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.66
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health SBD |
$139.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.57
|
| Rate for Payer: UHC Core |
$115.08
|
| Rate for Payer: UHC Exchange |
$86.81
|
| Rate for Payer: UMR Bronson Commercial |
$81.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.66
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$374.64
|
|
|
Service Code
|
NDC 00054006447
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.84 |
| Max. Negotiated Rate |
$337.18 |
| Rate for Payer: Aetna American Axle |
$243.52
|
| Rate for Payer: Aetna Commercial |
$318.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.52
|
| Rate for Payer: Cash Price |
$299.71
|
| Rate for Payer: Cofinity Advantage |
$262.25
|
| Rate for Payer: Cofinity Commercial |
$322.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$299.71
|
| Rate for Payer: Healthscope Commercial |
$337.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$262.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.98
|
| Rate for Payer: PHP Commercial |
$318.44
|
| Rate for Payer: Priority Health SBD |
$236.02
|
| Rate for Payer: UMR Bronson Commercial |
$164.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.98
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$151.53
|
|
|
Service Code
|
NDC 51672409103
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$136.38 |
| Rate for Payer: Aetna American Axle |
$98.49
|
| Rate for Payer: Aetna Commercial |
$128.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.49
|
| Rate for Payer: Cash Price |
$121.22
|
| Rate for Payer: Cofinity Advantage |
$106.07
|
| Rate for Payer: Cofinity Commercial |
$130.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$136.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.65
|
| Rate for Payer: PHP Commercial |
$128.80
|
| Rate for Payer: Priority Health SBD |
$95.46
|
| Rate for Payer: UMR Bronson Commercial |
$66.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.65
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$116.38
|
|
|
Service Code
|
NDC 65162069179
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.21 |
| Max. Negotiated Rate |
$104.74 |
| Rate for Payer: Aetna American Axle |
$75.65
|
| Rate for Payer: Aetna Commercial |
$98.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.65
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: Cofinity Advantage |
$81.47
|
| Rate for Payer: Cofinity Commercial |
$100.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.10
|
| Rate for Payer: Healthscope Commercial |
$104.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.28
|
| Rate for Payer: PHP Commercial |
$98.92
|
| Rate for Payer: Priority Health SBD |
$73.32
|
| Rate for Payer: UMR Bronson Commercial |
$51.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.28
|
|
