|
OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$99.64
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$89.68 |
| Rate for Payer: Aetna American Axle |
$64.77
|
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna Medicare |
$49.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.77
|
| Rate for Payer: BCBS Complete |
$39.86
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cofinity Commercial |
$69.75
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.71
|
| Rate for Payer: Healthscope Commercial |
$89.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.69
|
| Rate for Payer: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.77
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| Rate for Payer: UMR Bronson Commercial |
$36.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.73
|
|
|
OCTREOTIDE ACETATE 200 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$99.64
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
25123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.84 |
| Max. Negotiated Rate |
$89.68 |
| Rate for Payer: Aetna American Axle |
$64.77
|
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.77
|
| Rate for Payer: Cash Price |
$79.71
|
| Rate for Payer: Cofinity Commercial |
$69.75
|
| Rate for Payer: Cofinity Commercial |
$85.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.71
|
| Rate for Payer: Healthscope Commercial |
$89.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.69
|
| Rate for Payer: PHP Commercial |
$84.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.77
|
| Rate for Payer: Priority Health SBD |
$62.77
|
| Rate for Payer: UMR Bronson Commercial |
$43.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.73
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$48.59
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna American Axle |
$31.58
|
| Rate for Payer: Aetna American Axle |
$33.09
|
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Medicare |
$24.30
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.09
|
| Rate for Payer: BCBS Complete |
$20.36
|
| Rate for Payer: BCBS Complete |
$19.44
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Cofinity Commercial |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.27
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.09
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: UMR Bronson Commercial |
$17.98
|
| Rate for Payer: UMR Bronson Commercial |
$18.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.44
|
|
|
OCTREOTIDE ACETATE 500 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$48.59
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91281
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.38 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Aetna American Axle |
$31.58
|
| Rate for Payer: Aetna American Axle |
$33.09
|
| Rate for Payer: Aetna Commercial |
$41.30
|
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.09
|
| Rate for Payer: Cash Price |
$38.87
|
| Rate for Payer: Cash Price |
$40.73
|
| Rate for Payer: Cofinity Commercial |
$43.78
|
| Rate for Payer: Cofinity Commercial |
$35.64
|
| Rate for Payer: Cofinity Commercial |
$34.01
|
| Rate for Payer: Cofinity Commercial |
$41.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$34.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.73
|
| Rate for Payer: Healthscope Commercial |
$43.73
|
| Rate for Payer: Healthscope Commercial |
$45.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.30
|
| Rate for Payer: PHP Commercial |
$43.27
|
| Rate for Payer: PHP Commercial |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.09
|
| Rate for Payer: Priority Health SBD |
$30.61
|
| Rate for Payer: Priority Health SBD |
$32.07
|
| Rate for Payer: UMR Bronson Commercial |
$21.38
|
| Rate for Payer: UMR Bronson Commercial |
$22.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.18
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.63
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.11
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.63
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$16.77 |
| Rate for Payer: Aetna American Axle |
$12.11
|
| Rate for Payer: Aetna Commercial |
$15.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.11
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$13.04
|
| Rate for Payer: Cofinity Commercial |
$16.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$16.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.84
|
| Rate for Payer: PHP Commercial |
$15.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.11
|
| Rate for Payer: Priority Health SBD |
$11.74
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.97
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$8,842.60
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,890.74 |
| Max. Negotiated Rate |
$7,958.34 |
| Rate for Payer: Aetna American Axle |
$5,747.69
|
| Rate for Payer: Aetna Commercial |
$7,516.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,747.69
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Commercial |
$7,604.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,189.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.08
|
| Rate for Payer: Healthscope Commercial |
$7,958.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,189.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,631.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.21
|
| Rate for Payer: PHP Commercial |
$7,516.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,747.69
|
| Rate for Payer: Priority Health SBD |
$5,570.84
|
| Rate for Payer: UMR Bronson Commercial |
$3,890.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,631.95
|
|
|
OCTREOTIDE,MICROSPHERES ER 10 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$8,842.60
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.12 |
| Max. Negotiated Rate |
$7,958.34 |
| Rate for Payer: Aetna American Axle |
$5,747.69
|
| Rate for Payer: Aetna Commercial |
$7,516.21
|
| Rate for Payer: Aetna Medicare |
$211.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,747.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$254.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$254.47
|
| Rate for Payer: BCBS Complete |
$114.57
|
| Rate for Payer: BCBS MAPPO |
$203.58
|
| Rate for Payer: BCN Medicare Advantage |
$203.58
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cash Price |
$7,074.08
|
| Rate for Payer: Cofinity Commercial |
$7,604.64
|
| Rate for Payer: Cofinity Commercial |
$6,189.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$6,189.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,074.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.58
|
| Rate for Payer: Healthscope Commercial |
$7,958.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,189.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,631.95
|
| Rate for Payer: Mclaren Medicaid |
$109.12
|
| Rate for Payer: Mclaren Medicare |
$203.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.76
|
| Rate for Payer: Meridian Medicaid |
$114.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,516.21
|
| Rate for Payer: PACE Medicare |
$193.40
|
| Rate for Payer: PACE SWMI |
$203.58
|
| Rate for Payer: PHP Commercial |
$7,516.21
|
| Rate for Payer: PHP Medicare Advantage |
$203.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,747.69
|
| Rate for Payer: Priority Health Medicare |
$203.58
|
| Rate for Payer: Priority Health SBD |
$5,570.84
|
| Rate for Payer: Railroad Medicare Medicare |
$203.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.58
|
| Rate for Payer: UHC Exchange |
$389.06
|
| Rate for Payer: UHC Medicare Advantage |
$203.58
|
| Rate for Payer: UHCCP Medicaid |
$109.12
|
| Rate for Payer: UMR Bronson Commercial |
$3,271.76
|
| Rate for Payer: VA VA |
$203.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,631.95
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$11,585.32
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,097.54 |
| Max. Negotiated Rate |
$10,426.79 |
| Rate for Payer: Aetna American Axle |
$7,530.46
|
| Rate for Payer: Aetna Commercial |
$9,847.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,530.46
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cofinity Commercial |
$8,109.72
|
| Rate for Payer: Cofinity Commercial |
$9,963.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,109.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,268.26
|
| Rate for Payer: Healthscope Commercial |
$10,426.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,109.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,688.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,847.52
|
| Rate for Payer: PHP Commercial |
$9,847.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,530.46
|
| Rate for Payer: Priority Health SBD |
$7,298.75
|
| Rate for Payer: UMR Bronson Commercial |
$5,097.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,688.99
|
|
|
OCTREOTIDE,MICROSPHERES ER 20 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$11,585.32
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.12 |
| Max. Negotiated Rate |
$10,426.79 |
| Rate for Payer: Aetna American Axle |
$7,530.46
|
| Rate for Payer: Aetna Commercial |
$9,847.52
|
| Rate for Payer: Aetna Medicare |
$211.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,530.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$254.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$254.47
|
| Rate for Payer: BCBS Complete |
$114.57
|
| Rate for Payer: BCBS MAPPO |
$203.58
|
| Rate for Payer: BCN Medicare Advantage |
$203.58
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cash Price |
$9,268.26
|
| Rate for Payer: Cofinity Commercial |
$9,963.38
|
| Rate for Payer: Cofinity Commercial |
$8,109.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,109.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,268.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.58
|
| Rate for Payer: Healthscope Commercial |
$10,426.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,109.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,688.99
|
| Rate for Payer: Mclaren Medicaid |
$109.12
|
| Rate for Payer: Mclaren Medicare |
$203.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.76
|
| Rate for Payer: Meridian Medicaid |
$114.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,847.52
|
| Rate for Payer: PACE Medicare |
$193.40
|
| Rate for Payer: PACE SWMI |
$203.58
|
| Rate for Payer: PHP Commercial |
$9,847.52
|
| Rate for Payer: PHP Medicare Advantage |
$203.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,530.46
|
| Rate for Payer: Priority Health Medicare |
$203.58
|
| Rate for Payer: Priority Health SBD |
$7,298.75
|
| Rate for Payer: Railroad Medicare Medicare |
$203.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.58
|
| Rate for Payer: UHC Exchange |
$389.06
|
| Rate for Payer: UHC Medicare Advantage |
$203.58
|
| Rate for Payer: UHCCP Medicaid |
$109.12
|
| Rate for Payer: UMR Bronson Commercial |
$4,286.57
|
| Rate for Payer: VA VA |
$203.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,688.99
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
OP
|
$17,348.09
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.12 |
| Max. Negotiated Rate |
$15,613.28 |
| Rate for Payer: Aetna American Axle |
$11,276.26
|
| Rate for Payer: Aetna Commercial |
$14,745.88
|
| Rate for Payer: Aetna Medicare |
$211.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,276.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$254.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$254.47
|
| Rate for Payer: BCBS Complete |
$114.57
|
| Rate for Payer: BCBS MAPPO |
$203.58
|
| Rate for Payer: BCN Medicare Advantage |
$203.58
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cofinity Commercial |
$14,919.36
|
| Rate for Payer: Cofinity Commercial |
$12,143.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,143.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,878.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.58
|
| Rate for Payer: Healthscope Commercial |
$15,613.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,143.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,011.07
|
| Rate for Payer: Mclaren Medicaid |
$109.12
|
| Rate for Payer: Mclaren Medicare |
$203.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.76
|
| Rate for Payer: Meridian Medicaid |
$114.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$234.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,745.88
|
| Rate for Payer: PACE Medicare |
$193.40
|
| Rate for Payer: PACE SWMI |
$203.58
|
| Rate for Payer: PHP Commercial |
$14,745.88
|
| Rate for Payer: PHP Medicare Advantage |
$203.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,276.26
|
| Rate for Payer: Priority Health Medicare |
$203.58
|
| Rate for Payer: Priority Health SBD |
$10,929.30
|
| Rate for Payer: Railroad Medicare Medicare |
$203.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.58
|
| Rate for Payer: UHC Exchange |
$389.06
|
| Rate for Payer: UHC Medicare Advantage |
$203.58
|
| Rate for Payer: UHCCP Medicaid |
$109.12
|
| Rate for Payer: UMR Bronson Commercial |
$6,418.79
|
| Rate for Payer: VA VA |
$203.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,011.07
|
|
|
OCTREOTIDE,MICROSPHERES ER 30 MG INTRAMUSCULAR SUSP, EXTENDED RELEASE
|
Facility
|
IP
|
$17,348.09
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
161514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,633.16 |
| Max. Negotiated Rate |
$15,613.28 |
| Rate for Payer: Aetna American Axle |
$11,276.26
|
| Rate for Payer: Aetna Commercial |
$14,745.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,276.26
|
| Rate for Payer: Cash Price |
$13,878.47
|
| Rate for Payer: Cofinity Commercial |
$12,143.66
|
| Rate for Payer: Cofinity Commercial |
$14,919.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,143.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,878.47
|
| Rate for Payer: Healthscope Commercial |
$15,613.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,143.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,011.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,745.88
|
| Rate for Payer: PHP Commercial |
$14,745.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,276.26
|
| Rate for Payer: Priority Health SBD |
$10,929.30
|
| Rate for Payer: UMR Bronson Commercial |
$7,633.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,011.07
|
|
|
OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,641.40
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
100265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,162.22 |
| Max. Negotiated Rate |
$2,377.26 |
| Rate for Payer: Aetna American Axle |
$1,716.91
|
| Rate for Payer: Aetna Commercial |
$2,245.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.91
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cofinity Commercial |
$1,848.98
|
| Rate for Payer: Cofinity Commercial |
$2,271.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.12
|
| Rate for Payer: Healthscope Commercial |
$2,377.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,981.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.19
|
| Rate for Payer: PHP Commercial |
$2,245.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.91
|
| Rate for Payer: Priority Health SBD |
$1,664.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,162.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,981.05
|
|
|
OFATUMUMAB 100 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,641.40
|
|
|
Service Code
|
HCPCS J9302
|
| Hospital Charge Code |
100265
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$2,377.26 |
| Rate for Payer: Aetna American Axle |
$1,716.91
|
| Rate for Payer: Aetna Commercial |
$2,245.19
|
| Rate for Payer: Aetna Medicare |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.79
|
| Rate for Payer: BCBS Complete |
$35.02
|
| Rate for Payer: BCBS MAPPO |
$62.23
|
| Rate for Payer: BCN Medicare Advantage |
$62.23
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cash Price |
$2,113.12
|
| Rate for Payer: Cofinity Commercial |
$2,271.60
|
| Rate for Payer: Cofinity Commercial |
$1,848.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,848.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,113.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.23
|
| Rate for Payer: Healthscope Commercial |
$2,377.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,848.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,981.05
|
| Rate for Payer: Mclaren Medicaid |
$33.36
|
| Rate for Payer: Mclaren Medicare |
$62.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.34
|
| Rate for Payer: Meridian Medicaid |
$35.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.19
|
| Rate for Payer: PACE Medicare |
$59.12
|
| Rate for Payer: PACE SWMI |
$62.23
|
| Rate for Payer: PHP Commercial |
$2,245.19
|
| Rate for Payer: PHP Medicare Advantage |
$62.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,716.91
|
| Rate for Payer: Priority Health Medicare |
$62.23
|
| Rate for Payer: Priority Health SBD |
$1,664.08
|
| Rate for Payer: Railroad Medicare Medicare |
$62.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.23
|
| Rate for Payer: UHC Exchange |
$118.93
|
| Rate for Payer: UHC Medicare Advantage |
$62.23
|
| Rate for Payer: UHCCP Medicaid |
$33.36
|
| Rate for Payer: UMR Bronson Commercial |
$977.32
|
| Rate for Payer: VA VA |
$62.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,981.05
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna American Axle |
$16.93
|
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.93
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health SBD |
$16.41
|
| Rate for Payer: UMR Bronson Commercial |
$11.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$26.04
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$23.44 |
| Rate for Payer: Aetna American Axle |
$16.93
|
| Rate for Payer: Aetna Commercial |
$22.13
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.93
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$18.23
|
| Rate for Payer: Cofinity Commercial |
$22.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$23.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: PHP Commercial |
$22.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health SBD |
$16.41
|
| Rate for Payer: UMR Bronson Commercial |
$9.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.53
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$105.14
|
|
|
Service Code
|
NDC 60505056001
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.26 |
| Max. Negotiated Rate |
$94.63 |
| Rate for Payer: Aetna American Axle |
$68.34
|
| Rate for Payer: Aetna Commercial |
$89.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.34
|
| Rate for Payer: Cash Price |
$84.11
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$90.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.11
|
| Rate for Payer: Healthscope Commercial |
$94.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.37
|
| Rate for Payer: PHP Commercial |
$89.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.34
|
| Rate for Payer: Priority Health SBD |
$66.24
|
| Rate for Payer: UMR Bronson Commercial |
$46.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.86
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$105.14
|
|
|
Service Code
|
NDC 60505056001
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$94.63 |
| Rate for Payer: Aetna American Axle |
$68.34
|
| Rate for Payer: Aetna Commercial |
$89.37
|
| Rate for Payer: Aetna Medicare |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.34
|
| Rate for Payer: BCBS Complete |
$42.06
|
| Rate for Payer: Cash Price |
$84.11
|
| Rate for Payer: Cofinity Commercial |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$90.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$73.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.11
|
| Rate for Payer: Healthscope Commercial |
$94.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.37
|
| Rate for Payer: PHP Commercial |
$89.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.34
|
| Rate for Payer: Priority Health SBD |
$66.24
|
| Rate for Payer: UMR Bronson Commercial |
$38.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.86
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna American Axle |
$16.47
|
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna Medicare |
$12.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.47
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$21.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$22.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: PHP Commercial |
$21.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health SBD |
$15.96
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.00
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$45.29
|
|
|
Service Code
|
NDC 64980051501
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.93 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna American Axle |
$29.44
|
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.44
|
| Rate for Payer: Cash Price |
$36.23
|
| Rate for Payer: Cofinity Commercial |
$31.70
|
| Rate for Payer: Cofinity Commercial |
$38.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$40.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.50
|
| Rate for Payer: PHP Commercial |
$38.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.44
|
| Rate for Payer: Priority Health SBD |
$28.53
|
| Rate for Payer: UMR Bronson Commercial |
$19.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.97
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$45.29
|
|
|
Service Code
|
NDC 64980051501
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$40.76 |
| Rate for Payer: Aetna American Axle |
$29.44
|
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Aetna Medicare |
$22.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.44
|
| Rate for Payer: BCBS Complete |
$18.12
|
| Rate for Payer: Cash Price |
$36.23
|
| Rate for Payer: Cofinity Commercial |
$31.70
|
| Rate for Payer: Cofinity Commercial |
$38.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$40.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.50
|
| Rate for Payer: PHP Commercial |
$38.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.44
|
| Rate for Payer: Priority Health SBD |
$28.53
|
| Rate for Payer: UMR Bronson Commercial |
$16.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.97
|
|
|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna American Axle |
$16.47
|
| Rate for Payer: Aetna Commercial |
$21.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.47
|
| Rate for Payer: Cash Price |
$20.27
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$21.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.27
|
| Rate for Payer: Healthscope Commercial |
$22.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.54
|
| Rate for Payer: PHP Commercial |
$21.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.47
|
| Rate for Payer: Priority Health SBD |
$15.96
|
| Rate for Payer: UMR Bronson Commercial |
$11.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.00
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$118.56
|
|
|
Service Code
|
NDC 33342008407
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.87 |
| Max. Negotiated Rate |
$106.70 |
| Rate for Payer: Aetna American Axle |
$77.06
|
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Medicare |
$59.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.06
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: Cash Price |
$94.85
|
| Rate for Payer: Cofinity Commercial |
$101.96
|
| Rate for Payer: Cofinity Commercial |
$82.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$82.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.85
|
| Rate for Payer: Healthscope Commercial |
$106.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$82.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.78
|
| Rate for Payer: PHP Commercial |
$100.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.06
|
| Rate for Payer: Priority Health SBD |
$74.69
|
| Rate for Payer: UMR Bronson Commercial |
$43.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.92
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$8.75
|
|
|
Service Code
|
NDC 55111026379
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna American Axle |
$5.69
|
| Rate for Payer: Aetna Commercial |
$7.44
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.69
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cofinity Commercial |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.00
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.44
|
| Rate for Payer: PHP Commercial |
$7.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.69
|
| Rate for Payer: Priority Health SBD |
$5.51
|
| Rate for Payer: UMR Bronson Commercial |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.56
|
|
|
OLANZAPINE 10 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$262.30
|
|
|
Service Code
|
NDC 55111026381
|
| Hospital Charge Code |
28160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.41 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna American Axle |
$170.50
|
| Rate for Payer: Aetna Commercial |
$222.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.50
|
| Rate for Payer: Cash Price |
$209.84
|
| Rate for Payer: Cofinity Commercial |
$183.61
|
| Rate for Payer: Cofinity Commercial |
$225.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.84
|
| Rate for Payer: Healthscope Commercial |
$236.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.96
|
| Rate for Payer: PHP Commercial |
$222.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.50
|
| Rate for Payer: Priority Health SBD |
$165.25
|
| Rate for Payer: UMR Bronson Commercial |
$115.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.72
|
|
