|
OLANZAPINE 10 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00904637661
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
OLANZAPINE 10 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00904637661
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
NDC 59746030812
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$400.27
|
|
|
Service Code
|
NDC 00093524765
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.10 |
| Max. Negotiated Rate |
$360.24 |
| Rate for Payer: Aetna American Axle |
$260.18
|
| Rate for Payer: Aetna Commercial |
$340.23
|
| Rate for Payer: Aetna Medicare |
$200.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.18
|
| Rate for Payer: BCBS Complete |
$160.11
|
| Rate for Payer: Cash Price |
$320.22
|
| Rate for Payer: Cofinity Commercial |
$280.19
|
| Rate for Payer: Cofinity Commercial |
$344.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.22
|
| Rate for Payer: Healthscope Commercial |
$360.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.23
|
| Rate for Payer: PHP Commercial |
$340.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.18
|
| Rate for Payer: Priority Health SBD |
$252.17
|
| Rate for Payer: UMR Bronson Commercial |
$148.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.20
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
NDC 49884032252
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 59746030832
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$109.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$248.26
|
|
|
Service Code
|
NDC 59746030832
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.86 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$91.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$400.27
|
|
|
Service Code
|
NDC 00093524765
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.12 |
| Max. Negotiated Rate |
$360.24 |
| Rate for Payer: Aetna American Axle |
$260.18
|
| Rate for Payer: Aetna Commercial |
$340.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.18
|
| Rate for Payer: Cash Price |
$320.22
|
| Rate for Payer: Cofinity Commercial |
$280.19
|
| Rate for Payer: Cofinity Commercial |
$344.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.22
|
| Rate for Payer: Healthscope Commercial |
$360.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.23
|
| Rate for Payer: PHP Commercial |
$340.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.18
|
| Rate for Payer: Priority Health SBD |
$252.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.20
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 59746030812
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$125.86
|
|
|
Service Code
|
NDC 00002445501
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.57 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: Aetna American Axle |
$81.81
|
| Rate for Payer: Aetna Commercial |
$106.98
|
| Rate for Payer: Aetna Medicare |
$62.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.81
|
| Rate for Payer: BCBS Complete |
$50.34
|
| Rate for Payer: Cash Price |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.69
|
| Rate for Payer: Healthscope Commercial |
$113.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.98
|
| Rate for Payer: PHP Commercial |
$106.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.81
|
| Rate for Payer: Priority Health SBD |
$79.29
|
| Rate for Payer: UMR Bronson Commercial |
$46.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.39
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$12.90
|
|
|
Service Code
|
NDC 55111026479
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna American Axle |
$8.38
|
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna Medicare |
$6.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.38
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: PHP Commercial |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: UMR Bronson Commercial |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$248.26
|
|
|
Service Code
|
NDC 49884032255
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.86 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$91.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 49884032255
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$109.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$125.86
|
|
|
Service Code
|
NDC 00002445501
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$113.27 |
| Rate for Payer: Aetna American Axle |
$81.81
|
| Rate for Payer: Aetna Commercial |
$106.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.81
|
| Rate for Payer: Cash Price |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$108.24
|
| Rate for Payer: Cofinity Commercial |
$88.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.69
|
| Rate for Payer: Healthscope Commercial |
$113.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.98
|
| Rate for Payer: PHP Commercial |
$106.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.81
|
| Rate for Payer: Priority Health SBD |
$79.29
|
| Rate for Payer: UMR Bronson Commercial |
$55.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.39
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$248.26
|
|
|
Service Code
|
NDC 00378551293
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$109.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 49884032252
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$248.26
|
|
|
Service Code
|
NDC 00378551293
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.86 |
| Max. Negotiated Rate |
$223.43 |
| Rate for Payer: Aetna American Axle |
$161.37
|
| Rate for Payer: Aetna Commercial |
$211.02
|
| Rate for Payer: Aetna Medicare |
$124.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.37
|
| Rate for Payer: BCBS Complete |
$99.30
|
| Rate for Payer: Cash Price |
$198.61
|
| Rate for Payer: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.61
|
| Rate for Payer: Healthscope Commercial |
$223.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.02
|
| Rate for Payer: PHP Commercial |
$211.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.37
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$91.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.19
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$386.84
|
|
|
Service Code
|
NDC 55111026481
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$348.16 |
| Rate for Payer: Aetna American Axle |
$251.45
|
| Rate for Payer: Aetna Commercial |
$328.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.45
|
| Rate for Payer: Cash Price |
$309.47
|
| Rate for Payer: Cofinity Commercial |
$270.79
|
| Rate for Payer: Cofinity Commercial |
$332.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.47
|
| Rate for Payer: Healthscope Commercial |
$348.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.81
|
| Rate for Payer: PHP Commercial |
$328.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.45
|
| Rate for Payer: Priority Health SBD |
$243.71
|
| Rate for Payer: UMR Bronson Commercial |
$170.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.13
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$386.84
|
|
|
Service Code
|
NDC 55111026481
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.13 |
| Max. Negotiated Rate |
$348.16 |
| Rate for Payer: Aetna American Axle |
$251.45
|
| Rate for Payer: Aetna Commercial |
$328.81
|
| Rate for Payer: Aetna Medicare |
$193.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.45
|
| Rate for Payer: BCBS Complete |
$154.74
|
| Rate for Payer: Cash Price |
$309.47
|
| Rate for Payer: Cofinity Commercial |
$270.79
|
| Rate for Payer: Cofinity Commercial |
$332.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.47
|
| Rate for Payer: Healthscope Commercial |
$348.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.81
|
| Rate for Payer: PHP Commercial |
$328.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.45
|
| Rate for Payer: Priority Health SBD |
$243.71
|
| Rate for Payer: UMR Bronson Commercial |
$143.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.13
|
|
|
OLANZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$12.90
|
|
|
Service Code
|
NDC 55111026479
|
| Hospital Charge Code |
28161
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$11.61 |
| Rate for Payer: Aetna American Axle |
$8.38
|
| Rate for Payer: Aetna Commercial |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.38
|
| Rate for Payer: Cash Price |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$9.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$11.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.96
|
| Rate for Payer: PHP Commercial |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.38
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: UMR Bronson Commercial |
$5.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$58.52
|
|
|
Service Code
|
NDC 55111016330
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna American Axle |
$38.04
|
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Cofinity Commercial |
$40.96
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.82
|
| Rate for Payer: Healthscope Commercial |
$52.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.74
|
| Rate for Payer: PHP Commercial |
$49.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.04
|
| Rate for Payer: Priority Health SBD |
$36.87
|
| Rate for Payer: UMR Bronson Commercial |
$25.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.89
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$272.60
|
|
|
Service Code
|
NDC 00904628361
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: Cash Price |
$218.08
|
| Rate for Payer: Cofinity Commercial |
$190.82
|
| Rate for Payer: Cofinity Commercial |
$234.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.08
|
| Rate for Payer: Healthscope Commercial |
$245.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.71
|
| Rate for Payer: PHP Commercial |
$231.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.19
|
| Rate for Payer: Priority Health SBD |
$171.74
|
| Rate for Payer: UMR Bronson Commercial |
$119.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$88.07
|
|
|
Service Code
|
NDC 66993068030
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.75 |
| Max. Negotiated Rate |
$79.26 |
| Rate for Payer: Aetna American Axle |
$57.25
|
| Rate for Payer: Aetna Commercial |
$74.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.25
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$61.65
|
| Rate for Payer: Cofinity Commercial |
$75.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$79.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.86
|
| Rate for Payer: PHP Commercial |
$74.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$55.48
|
| Rate for Payer: UMR Bronson Commercial |
$38.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.05
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 33342006707
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.49
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$88.07
|
|
|
Service Code
|
NDC 66993068030
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$79.26 |
| Rate for Payer: Aetna American Axle |
$57.25
|
| Rate for Payer: Aetna Commercial |
$74.86
|
| Rate for Payer: Aetna Medicare |
$44.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.25
|
| Rate for Payer: BCBS Complete |
$35.23
|
| Rate for Payer: Cash Price |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$61.65
|
| Rate for Payer: Cofinity Commercial |
$75.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.46
|
| Rate for Payer: Healthscope Commercial |
$79.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.86
|
| Rate for Payer: PHP Commercial |
$74.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$55.48
|
| Rate for Payer: UMR Bronson Commercial |
$32.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.05
|
|
