|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
NDC 00002759701
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$155.89
|
|
|
Service Code
|
NDC 00517095501
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Medicare |
$77.94
|
| Rate for Payer: Aetna American Axle |
$101.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.33
|
| Rate for Payer: BCBS Complete |
$62.36
|
| Rate for Payer: Cash Price |
$124.71
|
| Rate for Payer: Cofinity Commercial |
$109.12
|
| Rate for Payer: Cofinity Commercial |
$134.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.71
|
| Rate for Payer: Healthscope Commercial |
$140.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.51
|
| Rate for Payer: PHP Commercial |
$132.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.33
|
| Rate for Payer: Priority Health SBD |
$98.21
|
| Rate for Payer: UMR Bronson Commercial |
$57.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.92
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$113.84
|
|
|
Service Code
|
NDC 00781315972
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna American Axle |
$74.00
|
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Medicare |
$56.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.00
|
| Rate for Payer: BCBS Complete |
$45.54
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Commercial |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health SBD |
$71.72
|
| Rate for Payer: UMR Bronson Commercial |
$42.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$113.84
|
|
|
Service Code
|
NDC 00781315972
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.09 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna American Axle |
$74.00
|
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.00
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Commercial |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health SBD |
$71.72
|
| Rate for Payer: UMR Bronson Commercial |
$50.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$53.89
|
|
|
Service Code
|
NDC 31722030801
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna American Axle |
$35.03
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.03
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: UMR Bronson Commercial |
$23.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
OLANZAPINE 10 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$53.89
|
|
|
Service Code
|
NDC 31722030801
|
| Hospital Charge Code |
200122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.94 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Aetna American Axle |
$35.03
|
| Rate for Payer: Aetna Commercial |
$45.81
|
| Rate for Payer: Aetna Medicare |
$26.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.03
|
| Rate for Payer: BCBS Complete |
$21.56
|
| Rate for Payer: Cash Price |
$43.11
|
| Rate for Payer: Cofinity Commercial |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$46.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.11
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.81
|
| Rate for Payer: PHP Commercial |
$45.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.03
|
| Rate for Payer: Priority Health SBD |
$33.95
|
| Rate for Payer: UMR Bronson Commercial |
$19.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.42
|
|
|
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 |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| 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 |
$274.72
|
| 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 10 MG TABLET
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 60505311300
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
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 |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| 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 |
$274.72
|
| 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
|
$446.50
|
|
|
Service Code
|
NDC 60505311300
|
| Hospital Charge Code |
17937
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.22
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$165.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
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
|
$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: Cofinity Commercial |
$173.78
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.78
|
| 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: 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 |
$186.20
|
| 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 |
$186.20
|
|
|
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
|
$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
|
$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 |
$186.20
|
| 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 |
$186.20
|
|
|
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 |
$94.40
|
| 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 |
$94.40
|
|
|
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 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 |
$186.20
|
| 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 |
$186.20
|
|
|
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 |
$186.20
|
| 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 |
$186.20
|
|
|
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 |
$94.40
|
| 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 |
$94.40
|
|
|
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 |
$200.14
|
| 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
|
$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
|
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 |
$186.20
|
| 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 |
$186.20
|
|
|
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
|
|
