|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 60505311000
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna Medicare |
$150.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$111.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$58.52
|
|
|
Service Code
|
NDC 55111016330
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$52.67 |
| Rate for Payer: Aetna American Axle |
$38.04
|
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna Medicare |
$29.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.04
|
| Rate for Payer: BCBS Complete |
$23.41
|
| 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 |
$21.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.89
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
NDC 69543038030
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna Medicare |
$46.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: BCBS Complete |
$37.22
|
| 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 |
$34.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
NDC 33342006707
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna Medicare |
$46.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: BCBS Complete |
$37.22
|
| 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 |
$34.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 69543038030
|
| 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
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 60505311000
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$132.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
OLANZAPINE 2.5 MG TABLET
|
Facility
|
OP
|
$272.60
|
|
|
Service Code
|
NDC 00904628361
|
| Hospital Charge Code |
21057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.86 |
| Max. Negotiated Rate |
$245.34 |
| Rate for Payer: Aetna American Axle |
$177.19
|
| Rate for Payer: Aetna Commercial |
$231.71
|
| Rate for Payer: Aetna Medicare |
$136.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$109.04
|
| 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 |
$100.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.45
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$68.69
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.42 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Aetna American Axle |
$44.65
|
| Rate for Payer: Aetna Commercial |
$58.39
|
| Rate for Payer: Aetna Medicare |
$34.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.65
|
| Rate for Payer: BCBS Complete |
$27.48
|
| Rate for Payer: Cash Price |
$54.95
|
| Rate for Payer: Cofinity Commercial |
$48.08
|
| Rate for Payer: Cofinity Commercial |
$59.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.95
|
| Rate for Payer: Healthscope Commercial |
$61.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.39
|
| Rate for Payer: PHP Commercial |
$58.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.65
|
| Rate for Payer: Priority Health SBD |
$43.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.52
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$206.79
|
|
|
Service Code
|
NDC 62756075164
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$186.11 |
| Rate for Payer: Aetna American Axle |
$134.41
|
| Rate for Payer: Aetna Commercial |
$175.77
|
| Rate for Payer: Aetna Medicare |
$103.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.41
|
| Rate for Payer: BCBS Complete |
$82.72
|
| Rate for Payer: Cash Price |
$165.43
|
| Rate for Payer: Cofinity Commercial |
$144.75
|
| Rate for Payer: Cofinity Commercial |
$177.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.43
|
| Rate for Payer: Healthscope Commercial |
$186.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.77
|
| Rate for Payer: PHP Commercial |
$175.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.41
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$76.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.09
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$114.63
|
|
|
Service Code
|
NDC 49884032055
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna Medicare |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.70
|
| Rate for Payer: Healthscope Commercial |
$103.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.51
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$8.31
|
|
|
Service Code
|
NDC 50268061511
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.48 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.65
|
| Rate for Payer: Healthscope Commercial |
$7.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.23
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health SBD |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$117.08
|
|
|
Service Code
|
NDC 00378551093
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$105.37 |
| Rate for Payer: Aetna American Axle |
$76.10
|
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.10
|
| Rate for Payer: Cash Price |
$93.66
|
| Rate for Payer: Cofinity Commercial |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$81.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.66
|
| Rate for Payer: Healthscope Commercial |
$105.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.52
|
| Rate for Payer: PHP Commercial |
$99.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.10
|
| Rate for Payer: Priority Health SBD |
$73.76
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.81
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$114.63
|
|
|
Service Code
|
NDC 60505327503
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.70
|
| Rate for Payer: Healthscope Commercial |
$103.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.51
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UMR Bronson Commercial |
$50.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$57.57
|
|
|
Service Code
|
NDC 00002445301
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna Medicare |
$28.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: BCBS Complete |
$23.03
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.42
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$21.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$206.79
|
|
|
Service Code
|
NDC 62756075164
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.11 |
| Rate for Payer: Aetna American Axle |
$134.41
|
| Rate for Payer: Aetna Commercial |
$175.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.41
|
| Rate for Payer: Cash Price |
$165.43
|
| Rate for Payer: Cofinity Commercial |
$144.75
|
| Rate for Payer: Cofinity Commercial |
$177.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.43
|
| Rate for Payer: Healthscope Commercial |
$186.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.77
|
| Rate for Payer: PHP Commercial |
$175.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.41
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.09
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$114.63
|
|
|
Service Code
|
NDC 60505327503
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.41 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna Medicare |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.70
|
| Rate for Payer: Healthscope Commercial |
$103.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.51
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UMR Bronson Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$114.63
|
|
|
Service Code
|
NDC 49884032055
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$103.17 |
| Rate for Payer: Aetna American Axle |
$74.51
|
| Rate for Payer: Aetna Commercial |
$97.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.51
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cofinity Commercial |
$80.24
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.70
|
| Rate for Payer: Healthscope Commercial |
$103.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.44
|
| Rate for Payer: PHP Commercial |
$97.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.51
|
| Rate for Payer: Priority Health SBD |
$72.22
|
| Rate for Payer: UMR Bronson Commercial |
$50.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.97
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$249.12
|
|
|
Service Code
|
NDC 50268061513
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna Medicare |
$124.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: BCBS Complete |
$99.65
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$214.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.93
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$249.12
|
|
|
Service Code
|
NDC 50268061513
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Aetna American Axle |
$161.93
|
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.93
|
| Rate for Payer: Cash Price |
$199.30
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$214.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$174.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.30
|
| Rate for Payer: Healthscope Commercial |
$224.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.75
|
| Rate for Payer: PHP Commercial |
$211.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.93
|
| Rate for Payer: Priority Health SBD |
$156.95
|
| Rate for Payer: UMR Bronson Commercial |
$109.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.84
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$57.57
|
|
|
Service Code
|
NDC 00002445301
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$51.81 |
| Rate for Payer: Aetna American Axle |
$37.42
|
| Rate for Payer: Aetna Commercial |
$48.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.42
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$40.30
|
| Rate for Payer: Cofinity Commercial |
$49.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.06
|
| Rate for Payer: Healthscope Commercial |
$51.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.93
|
| Rate for Payer: PHP Commercial |
$48.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.42
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: UMR Bronson Commercial |
$25.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.18
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$7.72
|
|
|
Service Code
|
NDC 55111026279
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.95 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.56
|
| Rate for Payer: Aetna Medicare |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Cofinity Commercial |
$6.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.56
|
| Rate for Payer: PHP Commercial |
$6.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.02
|
| Rate for Payer: Priority Health SBD |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.79
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$3.83
|
|
|
Service Code
|
NDC 49884032052
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: BCBS Complete |
$1.53
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$8.31
|
|
|
Service Code
|
NDC 50268061511
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.48 |
| Rate for Payer: Aetna American Axle |
$5.40
|
| Rate for Payer: Aetna Commercial |
$7.06
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.40
|
| Rate for Payer: BCBS Complete |
$3.32
|
| Rate for Payer: Cash Price |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.65
|
| Rate for Payer: Healthscope Commercial |
$7.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.06
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.40
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.23
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$3.83
|
|
|
Service Code
|
NDC 49884032052
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.45 |
| Rate for Payer: Aetna American Axle |
$2.49
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.49
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.49
|
| Rate for Payer: Priority Health SBD |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.87
|
|
