|
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
|
$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
|
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 |
$20.24 |
| 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 |
$39.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,945.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.20
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$37.76
|
| Rate for Payer: BCBS Trust/PPO |
$103.24
|
| Rate for Payer: BCN Commercial |
$103.24
|
| Rate for Payer: BCN Medicare Advantage |
$37.76
|
| 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 |
$37.76
|
| 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 |
$20.24
|
| Rate for Payer: Mclaren Medicare |
$37.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.65
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,851.85
|
| Rate for Payer: Nomi Health Commercial |
$113.28
|
| Rate for Payer: PACE Medicare |
$35.87
|
| Rate for Payer: PACE SWMI |
$37.76
|
| Rate for Payer: PHP Commercial |
$3,851.85
|
| Rate for Payer: PHP Medicare Advantage |
$37.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.20
|
| Rate for Payer: Priority Health Medicare |
$37.76
|
| Rate for Payer: Priority Health Narrow Network |
$88.16
|
| Rate for Payer: Priority Health SBD |
$2,854.90
|
| Rate for Payer: Railroad Medicare Medicare |
$37.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.76
|
| Rate for Payer: UHC Exchange |
$72.16
|
| Rate for Payer: UHC Medicare Advantage |
$37.76
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,676.69
|
| Rate for Payer: VA VA |
$37.76
|
| 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 |
$20.24 |
| 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 |
$39.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,945.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.20
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$37.76
|
| Rate for Payer: BCBS Trust/PPO |
$103.24
|
| Rate for Payer: BCN Commercial |
$103.24
|
| Rate for Payer: BCN Medicare Advantage |
$37.76
|
| 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 |
$37.76
|
| 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 |
$20.24
|
| Rate for Payer: Mclaren Medicare |
$37.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.65
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,851.85
|
| Rate for Payer: Nomi Health Commercial |
$113.28
|
| Rate for Payer: PACE Medicare |
$35.87
|
| Rate for Payer: PACE SWMI |
$37.76
|
| Rate for Payer: PHP Commercial |
$3,851.85
|
| Rate for Payer: PHP Medicare Advantage |
$37.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,945.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.20
|
| Rate for Payer: Priority Health Medicare |
$37.76
|
| Rate for Payer: Priority Health Narrow Network |
$88.16
|
| Rate for Payer: Priority Health SBD |
$2,854.90
|
| Rate for Payer: Railroad Medicare Medicare |
$37.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.76
|
| Rate for Payer: UHC Exchange |
$72.16
|
| Rate for Payer: UHC Medicare Advantage |
$37.76
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,676.69
|
| Rate for Payer: VA VA |
$37.76
|
| 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
|
IP
|
$2,265.80
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$996.95 |
| 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 New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Cash Price |
$1,812.64
|
| Rate for Payer: Cofinity Commercial |
$1,586.06
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,586.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.64
|
| 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: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.77
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
| Rate for Payer: UMR Bronson Commercial |
$996.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,699.35
|
|
|
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 |
$20.24 |
| 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 |
$39.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.20
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$37.76
|
| Rate for Payer: BCBS Trust/PPO |
$103.24
|
| Rate for Payer: BCN Commercial |
$103.24
|
| Rate for Payer: BCN Medicare Advantage |
$37.76
|
| 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 |
$37.76
|
| 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 |
$20.24
|
| Rate for Payer: Mclaren Medicare |
$37.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.65
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.93
|
| Rate for Payer: Nomi Health Commercial |
$113.28
|
| Rate for Payer: PACE Medicare |
$35.87
|
| Rate for Payer: PACE SWMI |
$37.76
|
| Rate for Payer: PHP Commercial |
$1,925.93
|
| Rate for Payer: PHP Medicare Advantage |
$37.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.20
|
| Rate for Payer: Priority Health Medicare |
$37.76
|
| Rate for Payer: Priority Health Narrow Network |
$88.16
|
| Rate for Payer: Priority Health SBD |
$1,427.45
|
| Rate for Payer: Railroad Medicare Medicare |
$37.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.76
|
| Rate for Payer: UHC Exchange |
$72.16
|
| Rate for Payer: UHC Medicare Advantage |
$37.76
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$838.35
|
| Rate for Payer: VA VA |
$37.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,699.35
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$434.88
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna American Axle |
$282.67
|
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: Aetna Medicare |
$217.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.67
|
| Rate for Payer: BCBS Complete |
$173.95
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cofinity Commercial |
$304.42
|
| Rate for Payer: Cofinity Commercial |
$374.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.90
|
| Rate for Payer: Healthscope Commercial |
$391.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.67
|
| Rate for Payer: Priority Health SBD |
$273.97
|
| Rate for Payer: UMR Bronson Commercial |
$160.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.16
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$547.08
|
|
|
Service Code
|
NDC 42806055212
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.42 |
| Max. Negotiated Rate |
$492.37 |
| Rate for Payer: Aetna American Axle |
$355.60
|
| Rate for Payer: Aetna Commercial |
$465.02
|
| Rate for Payer: Aetna Medicare |
$273.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: BCBS Complete |
$218.83
|
| Rate for Payer: Cash Price |
$437.66
|
| Rate for Payer: Cofinity Commercial |
$382.96
|
| Rate for Payer: Cofinity Commercial |
$470.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$382.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.66
|
| Rate for Payer: Healthscope Commercial |
$492.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$410.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.02
|
| Rate for Payer: PHP Commercial |
$465.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.60
|
| Rate for Payer: Priority Health SBD |
$344.66
|
| Rate for Payer: UMR Bronson Commercial |
$202.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$410.31
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$547.08
|
|
|
Service Code
|
NDC 42806055212
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$492.37 |
| Rate for Payer: Aetna American Axle |
$355.60
|
| Rate for Payer: Aetna Commercial |
$465.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.60
|
| Rate for Payer: Cash Price |
$437.66
|
| Rate for Payer: Cofinity Commercial |
$382.96
|
| Rate for Payer: Cofinity Commercial |
$470.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$382.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.66
|
| Rate for Payer: Healthscope Commercial |
$492.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$382.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$410.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.02
|
| Rate for Payer: PHP Commercial |
$465.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.60
|
| Rate for Payer: Priority Health SBD |
$344.66
|
| Rate for Payer: UMR Bronson Commercial |
$240.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$410.31
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$434.88
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.35 |
| Max. Negotiated Rate |
$391.39 |
| Rate for Payer: Aetna American Axle |
$282.67
|
| Rate for Payer: Aetna Commercial |
$369.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.67
|
| Rate for Payer: Cash Price |
$347.90
|
| Rate for Payer: Cofinity Commercial |
$304.42
|
| Rate for Payer: Cofinity Commercial |
$374.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.90
|
| Rate for Payer: Healthscope Commercial |
$391.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.65
|
| Rate for Payer: PHP Commercial |
$369.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.67
|
| Rate for Payer: Priority Health SBD |
$273.97
|
| Rate for Payer: UMR Bronson Commercial |
$191.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.16
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
IP
|
$100.61
|
|
|
Service Code
|
NDC 67544051030
|
| Hospital Charge Code |
27694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$90.55 |
| Rate for Payer: Aetna American Axle |
$65.40
|
| Rate for Payer: Aetna Commercial |
$85.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.40
|
| Rate for Payer: Cash Price |
$80.49
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Cofinity Commercial |
$86.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.49
|
| Rate for Payer: Healthscope Commercial |
$90.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.52
|
| Rate for Payer: PHP Commercial |
$85.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.40
|
| Rate for Payer: Priority Health SBD |
$63.38
|
| Rate for Payer: UMR Bronson Commercial |
$44.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.46
|
|
|
OMEPRAZOLE 20 MG CAPSULE,DELAYED RELEASE
|
Facility
|
OP
|
$100.61
|
|
|
Service Code
|
NDC 67544051030
|
| Hospital Charge Code |
27694
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.23 |
| Max. Negotiated Rate |
$90.55 |
| Rate for Payer: Aetna American Axle |
$65.40
|
| Rate for Payer: Aetna Commercial |
$85.52
|
| Rate for Payer: Aetna Medicare |
$50.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.40
|
| Rate for Payer: BCBS Complete |
$40.24
|
| Rate for Payer: Cash Price |
$80.49
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Cofinity Commercial |
$86.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.49
|
| Rate for Payer: Healthscope Commercial |
$90.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.52
|
| Rate for Payer: PHP Commercial |
$85.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.40
|
| Rate for Payer: Priority Health SBD |
$63.38
|
| Rate for Payer: UMR Bronson Commercial |
$37.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.46
|
|
|
OMEPRAZOLE 2 MG-SODIUM BICARBONATE 84 MG/ML ORAL SUSPENSION
|
Facility
|
OP
|
$742.18
|
|
|
Service Code
|
NDC 65628027203
|
| Hospital Charge Code |
203260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.61 |
| Max. Negotiated Rate |
$667.96 |
| Rate for Payer: Aetna American Axle |
$482.42
|
| Rate for Payer: Aetna Commercial |
$630.85
|
| Rate for Payer: Aetna Medicare |
$371.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.42
|
| Rate for Payer: BCBS Complete |
$296.87
|
| Rate for Payer: Cash Price |
$593.74
|
| Rate for Payer: Cofinity Commercial |
$519.53
|
| Rate for Payer: Cofinity Commercial |
$638.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$519.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$593.74
|
| Rate for Payer: Healthscope Commercial |
$667.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$519.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.85
|
| Rate for Payer: PHP Commercial |
$630.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.42
|
| Rate for Payer: Priority Health SBD |
$467.57
|
| Rate for Payer: UMR Bronson Commercial |
$274.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.64
|
|
|
OMEPRAZOLE 2 MG-SODIUM BICARBONATE 84 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$742.18
|
|
|
Service Code
|
NDC 65628027203
|
| Hospital Charge Code |
203260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.56 |
| Max. Negotiated Rate |
$667.96 |
| Rate for Payer: Aetna American Axle |
$482.42
|
| Rate for Payer: Aetna Commercial |
$630.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.42
|
| Rate for Payer: Cash Price |
$593.74
|
| Rate for Payer: Cofinity Commercial |
$519.53
|
| Rate for Payer: Cofinity Commercial |
$638.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$519.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$593.74
|
| Rate for Payer: Healthscope Commercial |
$667.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$519.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$556.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$630.85
|
| Rate for Payer: PHP Commercial |
$630.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.42
|
| Rate for Payer: Priority Health SBD |
$467.57
|
| Rate for Payer: UMR Bronson Commercial |
$326.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$556.64
|
|
|
ONABOTULINUMTOXINA 100 UNIT/3 ML INJECTION CUSTOM
|
Facility
|
IP
|
$1,923.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
180907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$846.21 |
| Max. Negotiated Rate |
$1,730.88 |
| Rate for Payer: Aetna American Axle |
$1,250.08
|
| Rate for Payer: Aetna Commercial |
$1,634.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.08
|
| Rate for Payer: Cash Price |
$1,538.56
|
| Rate for Payer: Cofinity Commercial |
$1,346.24
|
| Rate for Payer: Cofinity Commercial |
$1,653.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,346.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.56
|
| Rate for Payer: Healthscope Commercial |
$1,730.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,346.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.72
|
| Rate for Payer: PHP Commercial |
$1,634.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.08
|
| Rate for Payer: Priority Health SBD |
$1,211.62
|
| Rate for Payer: UMR Bronson Commercial |
$846.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT/3 ML INJECTION CUSTOM
|
Facility
|
OP
|
$1,923.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
180907
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$1,730.88 |
| Rate for Payer: Aetna American Axle |
$1,250.08
|
| Rate for Payer: Aetna Commercial |
$1,634.72
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,250.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$17.36
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$1,538.56
|
| Rate for Payer: Cash Price |
$1,538.56
|
| Rate for Payer: Cofinity Commercial |
$1,653.95
|
| Rate for Payer: Cofinity Commercial |
$1,346.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,346.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,538.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$1,730.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,346.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,442.40
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.72
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$1,634.72
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$14.74
|
| Rate for Payer: Priority Health SBD |
$1,211.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$12.36
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: UMR Bronson Commercial |
$711.58
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,442.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$2,067.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna American Axle |
$1,343.68
|
| Rate for Payer: Aetna Commercial |
$1,757.12
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,343.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.09
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$17.36
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| Rate for Payer: Cash Price |
$1,653.76
|
| Rate for Payer: Cash Price |
$1,653.76
|
| Rate for Payer: Cofinity Commercial |
$1,777.79
|
| Rate for Payer: Cofinity Commercial |
$1,447.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,447.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,653.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$1,860.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,447.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,550.40
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Mclaren Medicare |
$6.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.12
|
| Rate for Payer: Nomi Health Commercial |
$19.41
|
| Rate for Payer: PACE Medicare |
$6.15
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$1,757.12
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Medicare |
$6.47
|
| Rate for Payer: Priority Health Narrow Network |
$14.74
|
| Rate for Payer: Priority Health SBD |
$1,302.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$12.36
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: UMR Bronson Commercial |
$764.86
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,550.40
|
|
|
ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$2,067.20
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$909.57 |
| Max. Negotiated Rate |
$1,860.48 |
| Rate for Payer: Aetna American Axle |
$1,343.68
|
| Rate for Payer: Aetna Commercial |
$1,757.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,343.68
|
| Rate for Payer: Cash Price |
$1,653.76
|
| Rate for Payer: Cofinity Commercial |
$1,447.04
|
| Rate for Payer: Cofinity Commercial |
$1,777.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,447.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,653.76
|
| Rate for Payer: Healthscope Commercial |
$1,860.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,447.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,550.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.12
|
| Rate for Payer: PHP Commercial |
$1,757.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.68
|
| Rate for Payer: Priority Health SBD |
$1,302.34
|
| Rate for Payer: UMR Bronson Commercial |
$909.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,550.40
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.41
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.57 |
| Max. Negotiated Rate |
$59.77 |
| Rate for Payer: Aetna American Axle |
$43.17
|
| Rate for Payer: Aetna Commercial |
$56.45
|
| Rate for Payer: Aetna Medicare |
$33.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.17
|
| Rate for Payer: BCBS Complete |
$26.56
|
| Rate for Payer: Cash Price |
$53.13
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.13
|
| Rate for Payer: Healthscope Commercial |
$59.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.45
|
| Rate for Payer: PHP Commercial |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.17
|
| Rate for Payer: Priority Health SBD |
$41.84
|
| Rate for Payer: UMR Bronson Commercial |
$24.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.81
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 62756024064
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.26
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.46
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 62756024060
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$81.94
|
|
|
Service Code
|
NDC 00378773293
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$73.75 |
| Rate for Payer: PHP Commercial |
$69.65
|
| Rate for Payer: Aetna American Axle |
$53.26
|
| Rate for Payer: Aetna Commercial |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.26
|
| Rate for Payer: Cash Price |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$57.36
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$73.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.26
|
| Rate for Payer: Priority Health SBD |
$51.62
|
| Rate for Payer: UMR Bronson Commercial |
$36.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.46
|
|
