|
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
|
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
|
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
|
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 |
$103.40
|
| 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
|
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
|
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: Cofinity Commercial |
$100.69
|
| Rate for Payer: Cofinity Commercial |
$81.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.96
|
| Rate for Payer: Cash Price |
$93.66
|
| 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: 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
|
$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
|
$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
|
$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 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
|
$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 |
$2.14
|
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| 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 |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| 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
|
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 |
$2.14
|
| Rate for Payer: Aetna Commercial |
$2.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.14
|
| 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 |
$2.80
|
| Rate for Payer: PHP Commercial |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| 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
|
IP
|
$329.65
|
|
|
Service Code
|
NDC 68084072301
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$296.68 |
| 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 |
$230.76
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.72
|
| Rate for Payer: Healthscope Commercial |
$296.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.76
|
| 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
|
$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
|
$329.65
|
|
|
Service Code
|
NDC 68084072301
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.97 |
| Max. Negotiated Rate |
$296.68 |
| 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 |
$230.76
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.72
|
| Rate for Payer: Healthscope Commercial |
$296.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.76
|
| 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
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| 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 |
$198.58
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$113.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
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 |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| 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 |
$198.58
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| 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
|
$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
|
$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 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
|
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
|
$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
|
$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
|
$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
|
|
