|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$117.08
|
|
|
Service Code
|
NDC 00378551093
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$105.37 |
| Rate for Payer: Aetna American Axle |
$76.10
|
| Rate for Payer: Aetna Commercial |
$99.52
|
| Rate for Payer: Aetna Medicare |
$58.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.10
|
| Rate for Payer: BCBS Complete |
$46.83
|
| 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 |
$43.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.81
|
|
|
OLANZAPINE 5 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$68.69
|
|
|
Service Code
|
NDC 33342008307
|
| Hospital Charge Code |
28159
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$61.82 |
| Rate for Payer: Aetna American Axle |
$44.65
|
| Rate for Payer: Aetna Commercial |
$58.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.65
|
| 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 |
$30.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.52
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$329.65
|
|
|
Service Code
|
NDC 68084072301
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$296.69 |
| Rate for Payer: Aetna American Axle |
$214.27
|
| Rate for Payer: Aetna Commercial |
$280.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.27
|
| Rate for Payer: Cash Price |
$263.72
|
| Rate for Payer: Cofinity Commercial |
$230.75
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.72
|
| Rate for Payer: Healthscope Commercial |
$296.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.20
|
| Rate for Payer: PHP Commercial |
$280.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.27
|
| Rate for Payer: Priority Health SBD |
$207.68
|
| Rate for Payer: UMR Bronson Commercial |
$145.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.24
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$3.30
|
|
|
Service Code
|
NDC 68084072311
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health SBD |
$2.08
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
NDC 68084072311
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$2.97 |
| Rate for Payer: Aetna American Axle |
$2.15
|
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.15
|
| Rate for Payer: BCBS Complete |
$1.32
|
| Rate for Payer: Cash Price |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.64
|
| Rate for Payer: Healthscope Commercial |
$2.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.81
|
| Rate for Payer: PHP Commercial |
$2.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health SBD |
$2.08
|
| Rate for Payer: UMR Bronson Commercial |
$1.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.48
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$98.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$329.65
|
|
|
Service Code
|
NDC 68084072301
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$296.69 |
| Rate for Payer: Aetna American Axle |
$214.27
|
| Rate for Payer: Aetna Commercial |
$280.20
|
| Rate for Payer: Aetna Medicare |
$164.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.27
|
| Rate for Payer: BCBS Complete |
$131.86
|
| Rate for Payer: Cash Price |
$263.72
|
| Rate for Payer: Cofinity Commercial |
$230.75
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.72
|
| Rate for Payer: Healthscope Commercial |
$296.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.20
|
| Rate for Payer: PHP Commercial |
$280.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.27
|
| Rate for Payer: Priority Health SBD |
$207.68
|
| Rate for Payer: UMR Bronson Commercial |
$121.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.24
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$21.88
|
|
|
Service Code
|
NDC 60505057501
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$8.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.41
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$20.16
|
|
|
Service Code
|
NDC 17478010505
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$18.14 |
| Rate for Payer: Aetna American Axle |
$13.10
|
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.10
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cofinity Commercial |
$14.11
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.10
|
| Rate for Payer: Priority Health SBD |
$12.70
|
| Rate for Payer: UMR Bronson Commercial |
$8.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.12
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$20.16
|
|
|
Service Code
|
NDC 17478010505
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$18.14 |
| Rate for Payer: Aetna American Axle |
$13.10
|
| Rate for Payer: Aetna Commercial |
$17.14
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.10
|
| Rate for Payer: BCBS Complete |
$8.06
|
| Rate for Payer: Cash Price |
$16.13
|
| Rate for Payer: Cofinity Commercial |
$14.11
|
| Rate for Payer: Cofinity Commercial |
$17.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.13
|
| Rate for Payer: Healthscope Commercial |
$18.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.14
|
| Rate for Payer: PHP Commercial |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.10
|
| Rate for Payer: Priority Health SBD |
$12.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.12
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$42.67
|
|
|
Service Code
|
NDC 70069000701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna American Axle |
$27.74
|
| Rate for Payer: Aetna Commercial |
$36.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Commercial |
$29.87
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.27
|
| Rate for Payer: PHP Commercial |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.74
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: UMR Bronson Commercial |
$18.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$42.67
|
|
|
Service Code
|
NDC 70069000701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna American Axle |
$27.74
|
| Rate for Payer: Aetna Commercial |
$36.27
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: BCBS Complete |
$17.07
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Commercial |
$29.87
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.27
|
| Rate for Payer: PHP Commercial |
$36.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.74
|
| Rate for Payer: Priority Health SBD |
$26.88
|
| Rate for Payer: UMR Bronson Commercial |
$15.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.00
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$21.88
|
|
|
Service Code
|
NDC 60505057501
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$19.69 |
| Rate for Payer: Aetna American Axle |
$14.22
|
| Rate for Payer: Aetna Commercial |
$18.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$15.32
|
| Rate for Payer: Cofinity Commercial |
$18.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.60
|
| Rate for Payer: PHP Commercial |
$18.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.22
|
| Rate for Payer: Priority Health SBD |
$13.78
|
| Rate for Payer: UMR Bronson Commercial |
$9.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.41
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$24.08
|
|
|
Service Code
|
NDC 70512052005
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna American Axle |
$15.65
|
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.65
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.26
|
| Rate for Payer: Healthscope Commercial |
$21.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.47
|
| Rate for Payer: PHP Commercial |
$20.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.65
|
| Rate for Payer: Priority Health SBD |
$15.17
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.06
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$24.08
|
|
|
Service Code
|
NDC 70069001701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna American Axle |
$15.65
|
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.65
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.26
|
| Rate for Payer: Healthscope Commercial |
$21.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.47
|
| Rate for Payer: PHP Commercial |
$20.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.65
|
| Rate for Payer: Priority Health SBD |
$15.17
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.06
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$24.08
|
|
|
Service Code
|
NDC 70069001701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna American Axle |
$15.65
|
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.65
|
| Rate for Payer: BCBS Complete |
$9.63
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.26
|
| Rate for Payer: Healthscope Commercial |
$21.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.47
|
| Rate for Payer: PHP Commercial |
$20.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.65
|
| Rate for Payer: Priority Health SBD |
$15.17
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.06
|
|
|
OLOPATADINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$24.08
|
|
|
Service Code
|
NDC 70512052005
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$21.67 |
| Rate for Payer: Aetna American Axle |
$15.65
|
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.65
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.26
|
| Rate for Payer: Healthscope Commercial |
$21.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.47
|
| Rate for Payer: PHP Commercial |
$20.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.65
|
| Rate for Payer: Priority Health SBD |
$15.17
|
| Rate for Payer: UMR Bronson Commercial |
$10.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.06
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,531.59
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,993.90 |
| Max. Negotiated Rate |
$4,078.43 |
| Rate for Payer: Aetna American Axle |
$2,945.53
|
| Rate for Payer: Aetna Commercial |
$3,851.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,945.53
|
| Rate for Payer: Cash Price |
$3,625.27
|
| Rate for Payer: Cofinity Commercial |
$3,172.11
|
| Rate for Payer: Cofinity Commercial |
$3,897.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,172.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,625.27
|
| Rate for Payer: Healthscope Commercial |
$4,078.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,172.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,398.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,851.85
|
| Rate for Payer: PHP Commercial |
$3,851.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.53
|
| Rate for Payer: Priority Health SBD |
$2,854.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,993.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,398.69
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,531.59
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$4,078.43 |
| Rate for Payer: Aetna American Axle |
$2,945.53
|
| Rate for Payer: Aetna Commercial |
$3,851.85
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,945.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.75
|
| Rate for Payer: BCBS Complete |
$25.10
|
| Rate for Payer: BCBS MAPPO |
$44.60
|
| Rate for Payer: BCN Medicare Advantage |
$44.60
|
| Rate for Payer: Cash Price |
$3,625.27
|
| Rate for Payer: Cash Price |
$3,625.27
|
| Rate for Payer: Cofinity Commercial |
$3,897.17
|
| Rate for Payer: Cofinity Commercial |
$3,172.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,172.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,625.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$4,078.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,172.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,398.69
|
| Rate for Payer: Mclaren Medicaid |
$23.91
|
| Rate for Payer: Mclaren Medicare |
$44.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.83
|
| Rate for Payer: Meridian Medicaid |
$25.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,851.85
|
| Rate for Payer: PACE Medicare |
$42.37
|
| Rate for Payer: PACE SWMI |
$44.60
|
| Rate for Payer: PHP Commercial |
$3,851.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.53
|
| Rate for Payer: Priority Health Medicare |
$44.60
|
| Rate for Payer: Priority Health SBD |
$2,854.90
|
| Rate for Payer: Railroad Medicare Medicare |
$44.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.60
|
| Rate for Payer: UHC Exchange |
$85.24
|
| Rate for Payer: UHC Medicare Advantage |
$44.60
|
| Rate for Payer: UHCCP Medicaid |
$23.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,676.69
|
| Rate for Payer: VA VA |
$44.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,398.69
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,531.59
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$4,078.43 |
| Rate for Payer: Aetna American Axle |
$2,945.53
|
| Rate for Payer: Aetna Commercial |
$3,851.85
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,945.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.75
|
| Rate for Payer: BCBS Complete |
$25.10
|
| Rate for Payer: BCBS MAPPO |
$44.60
|
| Rate for Payer: BCN Medicare Advantage |
$44.60
|
| Rate for Payer: Cash Price |
$3,625.27
|
| Rate for Payer: Cash Price |
$3,625.27
|
| Rate for Payer: Cofinity Commercial |
$3,897.17
|
| Rate for Payer: Cofinity Commercial |
$3,172.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,172.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,625.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$4,078.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,172.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,398.69
|
| Rate for Payer: Mclaren Medicaid |
$23.91
|
| Rate for Payer: Mclaren Medicare |
$44.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.83
|
| Rate for Payer: Meridian Medicaid |
$25.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,851.85
|
| Rate for Payer: PACE Medicare |
$42.37
|
| Rate for Payer: PACE SWMI |
$44.60
|
| Rate for Payer: PHP Commercial |
$3,851.85
|
| Rate for Payer: PHP Medicare Advantage |
$44.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.53
|
| Rate for Payer: Priority Health Medicare |
$44.60
|
| Rate for Payer: Priority Health SBD |
$2,854.90
|
| Rate for Payer: Railroad Medicare Medicare |
$44.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.60
|
| Rate for Payer: UHC Exchange |
$85.24
|
| Rate for Payer: UHC Medicare Advantage |
$44.60
|
| Rate for Payer: UHCCP Medicaid |
$23.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,676.69
|
| Rate for Payer: VA VA |
$44.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,398.69
|
|
|
OMALIZUMAB 150 MG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,531.59
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,993.90 |
| Max. Negotiated Rate |
$4,078.43 |
| Rate for Payer: Aetna American Axle |
$2,945.53
|
| Rate for Payer: Aetna Commercial |
$3,851.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,945.53
|
| Rate for Payer: Cash Price |
$3,625.27
|
| Rate for Payer: Cofinity Commercial |
$3,172.11
|
| Rate for Payer: Cofinity Commercial |
$3,897.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,172.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,625.27
|
| Rate for Payer: Healthscope Commercial |
$4,078.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,172.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,398.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,851.85
|
| Rate for Payer: PHP Commercial |
$3,851.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.53
|
| Rate for Payer: Priority Health SBD |
$2,854.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,993.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,398.69
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$2,265.80
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$2,039.22 |
| Rate for Payer: Aetna American Axle |
$1,472.77
|
| Rate for Payer: Aetna Commercial |
$1,925.93
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.75
|
| Rate for Payer: BCBS Complete |
$25.10
|
| Rate for Payer: BCBS MAPPO |
$44.60
|
| Rate for Payer: BCN Medicare Advantage |
$44.60
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Cofinity Commercial |
$1,586.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,586.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$2,039.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,586.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,699.35
|
| Rate for Payer: Mclaren Medicaid |
$23.91
|
| Rate for Payer: Mclaren Medicare |
$44.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.83
|
| Rate for Payer: Meridian Medicaid |
$25.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: PACE Medicare |
$42.37
|
| Rate for Payer: PACE SWMI |
$44.60
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: PHP Medicare Advantage |
$44.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.77
|
| Rate for Payer: Priority Health Medicare |
$44.60
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
| Rate for Payer: Railroad Medicare Medicare |
$44.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.60
|
| Rate for Payer: UHC Exchange |
$85.24
|
| Rate for Payer: UHC Medicare Advantage |
$44.60
|
| Rate for Payer: UHCCP Medicaid |
$23.91
|
| Rate for Payer: UMR Bronson Commercial |
$838.35
|
| Rate for Payer: VA VA |
$44.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,699.35
|
|
