|
OFLOXACIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$31.29
|
|
|
Service Code
|
NDC 70756060730
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Aetna Commercial |
$28.16
|
| Rate for Payer: Aetna Medicare |
$11.58
|
| Rate for Payer: ASR ASR |
$30.35
|
| Rate for Payer: BCBS Complete |
$12.52
|
| Rate for Payer: BCBS Trust/PPO |
$25.80
|
| Rate for Payer: BCN Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$25.03
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.03
|
| Rate for Payer: Healthscope Commercial |
$30.35
|
| Rate for Payer: Healthscope Whirlpool |
$31.29
|
| Rate for Payer: Mclaren Commercial |
$28.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.60
|
| Rate for Payer: Nomi Health Commercial |
$25.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27.42
|
| Rate for Payer: Priority Health Narrow Network |
$21.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.54
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$54.42
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$54.42 |
| Rate for Payer: Aetna Commercial |
$48.98
|
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: Aetna Medicare |
$20.14
|
| Rate for Payer: ASR ASR |
$52.79
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCBS Complete |
$21.77
|
| Rate for Payer: BCBS Trust/PPO |
$44.87
|
| Rate for Payer: BCBS Trust/PPO |
$40.10
|
| Rate for Payer: BCN Commercial |
$40.10
|
| Rate for Payer: BCN Commercial |
$44.87
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Cofinity Commercial |
$51.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$52.79
|
| Rate for Payer: Healthscope Commercial |
$47.18
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Healthscope Whirlpool |
$48.64
|
| Rate for Payer: Mclaren Commercial |
$48.98
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.26
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: Nomi Health Commercial |
$44.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.84
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: Priority Health Narrow Network |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.89
|
|
|
OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$48.64
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$48.64 |
| Rate for Payer: Aetna Commercial |
$43.78
|
| Rate for Payer: Aetna Commercial |
$48.98
|
| Rate for Payer: ASR ASR |
$52.79
|
| Rate for Payer: ASR ASR |
$47.18
|
| Rate for Payer: BCBS Trust/PPO |
$44.69
|
| Rate for Payer: BCBS Trust/PPO |
$39.94
|
| Rate for Payer: BCN Commercial |
$44.69
|
| Rate for Payer: BCN Commercial |
$39.94
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$38.91
|
| Rate for Payer: Cofinity Commercial |
$45.72
|
| Rate for Payer: Cofinity Commercial |
$51.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.91
|
| Rate for Payer: Healthscope Commercial |
$47.18
|
| Rate for Payer: Healthscope Commercial |
$52.79
|
| Rate for Payer: Healthscope Whirlpool |
$54.42
|
| Rate for Payer: Healthscope Whirlpool |
$48.64
|
| Rate for Payer: Mclaren Commercial |
$48.98
|
| Rate for Payer: Mclaren Commercial |
$43.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.34
|
| Rate for Payer: Nomi Health Commercial |
$44.63
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.89
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$72.62
|
|
|
Service Code
|
NDC 43598016430
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.46 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Aetna Commercial |
$65.35
|
| Rate for Payer: ASR ASR |
$70.44
|
| Rate for Payer: BCBS Trust/PPO |
$59.63
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$58.09
|
| Rate for Payer: Cofinity Commercial |
$68.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.09
|
| Rate for Payer: Healthscope Commercial |
$70.44
|
| Rate for Payer: Healthscope Whirlpool |
$72.61
|
| Rate for Payer: Mclaren Commercial |
$65.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.72
|
| Rate for Payer: Nomi Health Commercial |
$59.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.90
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.12 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: ASR ASR |
$296.33
|
| Rate for Payer: BCBS Trust/PPO |
$250.88
|
| Rate for Payer: BCN Commercial |
$250.88
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$296.33
|
| Rate for Payer: Healthscope Whirlpool |
$305.50
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$1,625.93
|
|
|
Service Code
|
NDC 2411530
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,219.45 |
| Max. Negotiated Rate |
$1,625.93 |
| Rate for Payer: Aetna Commercial |
$1,463.34
|
| Rate for Payer: ASR ASR |
$1,577.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,335.21
|
| Rate for Payer: BCN Commercial |
$1,335.21
|
| Rate for Payer: Cash Price |
$1,300.74
|
| Rate for Payer: Cofinity Commercial |
$1,528.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,300.74
|
| Rate for Payer: Healthscope Commercial |
$1,577.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,625.93
|
| Rate for Payer: Mclaren Commercial |
$1,463.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,382.04
|
| Rate for Payer: Nomi Health Commercial |
$1,333.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,430.82
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: Aetna Medicare |
$113.03
|
| Rate for Payer: ASR ASR |
$296.33
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: BCBS Trust/PPO |
$251.88
|
| Rate for Payer: BCN Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$296.33
|
| Rate for Payer: Healthscope Whirlpool |
$305.50
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.68
|
| Rate for Payer: Priority Health Narrow Network |
$214.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: Aetna Medicare |
$124.34
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: BCBS Trust/PPO |
$277.07
|
| Rate for Payer: BCN Commercial |
$277.07
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$325.97
|
| Rate for Payer: Healthscope Whirlpool |
$336.05
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$294.45
|
| Rate for Payer: Priority Health Narrow Network |
$235.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.04 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: BCBS Trust/PPO |
$275.96
|
| Rate for Payer: BCN Commercial |
$275.96
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$325.97
|
| Rate for Payer: Healthscope Whirlpool |
$336.05
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$1,625.93
|
|
|
Service Code
|
NDC 2411530
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$601.59 |
| Max. Negotiated Rate |
$1,625.93 |
| Rate for Payer: Aetna Commercial |
$1,463.34
|
| Rate for Payer: Aetna Medicare |
$601.59
|
| Rate for Payer: ASR ASR |
$1,577.15
|
| Rate for Payer: BCBS Complete |
$650.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.58
|
| Rate for Payer: BCN Commercial |
$1,340.58
|
| Rate for Payer: Cash Price |
$1,300.74
|
| Rate for Payer: Cofinity Commercial |
$1,528.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,300.74
|
| Rate for Payer: Healthscope Commercial |
$1,577.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,625.93
|
| Rate for Payer: Mclaren Commercial |
$1,463.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,300.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,382.04
|
| Rate for Payer: Nomi Health Commercial |
$1,333.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,219.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,424.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,430.82
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$72.62
|
|
|
Service Code
|
NDC 43598016430
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$72.61 |
| Rate for Payer: Aetna Commercial |
$65.35
|
| Rate for Payer: Aetna Medicare |
$26.87
|
| Rate for Payer: ASR ASR |
$70.44
|
| Rate for Payer: BCBS Complete |
$29.05
|
| Rate for Payer: BCBS Trust/PPO |
$59.87
|
| Rate for Payer: BCN Commercial |
$59.87
|
| Rate for Payer: Cash Price |
$58.09
|
| Rate for Payer: Cofinity Commercial |
$68.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.09
|
| Rate for Payer: Healthscope Commercial |
$70.44
|
| Rate for Payer: Healthscope Whirlpool |
$72.61
|
| Rate for Payer: Mclaren Commercial |
$65.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.72
|
| Rate for Payer: Nomi Health Commercial |
$59.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$63.63
|
| Rate for Payer: Priority Health Narrow Network |
$50.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.90
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$4,972.03
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,729.02 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$4,474.83
|
| Rate for Payer: ASR ASR |
$4,822.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.03
|
| Rate for Payer: BCN Commercial |
$4,083.03
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Commercial |
$4,673.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Healthscope Commercial |
$4,822.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,972.03
|
| Rate for Payer: Mclaren Commercial |
$4,474.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$4,077.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,375.39
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$4,972.03
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206403
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$4,474.83
|
| Rate for Payer: Aetna Medicare |
$41.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: ASR ASR |
$4,822.87
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,099.44
|
| Rate for Payer: BCN Commercial |
$4,099.44
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Commercial |
$4,673.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$4,822.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,972.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.82
|
| Rate for Payer: Mclaren Commercial |
$4,474.83
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$22.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$4,077.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.02
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicaid |
$22.42
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.22
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health Narrow Network |
$37.78
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,375.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$64.82
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP DNSP |
$41.82
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,972.03
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,729.02 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$4,474.83
|
| Rate for Payer: ASR ASR |
$4,822.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.03
|
| Rate for Payer: BCN Commercial |
$4,083.03
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Commercial |
$4,673.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Healthscope Commercial |
$4,822.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,972.03
|
| Rate for Payer: Mclaren Commercial |
$4,474.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$4,077.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,375.39
|
|
|
OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,972.03
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$4,972.03 |
| Rate for Payer: Aetna Commercial |
$4,474.83
|
| Rate for Payer: Aetna Medicare |
$41.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: ASR ASR |
$4,822.87
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$4,099.44
|
| Rate for Payer: BCN Commercial |
$4,099.44
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cash Price |
$3,977.63
|
| Rate for Payer: Cofinity Commercial |
$4,673.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,977.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$4,822.87
|
| Rate for Payer: Healthscope Whirlpool |
$4,972.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.82
|
| Rate for Payer: Mclaren Commercial |
$4,474.83
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$22.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,226.23
|
| Rate for Payer: Nomi Health Commercial |
$4,077.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,729.02
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicaid |
$22.42
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.22
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health Narrow Network |
$37.78
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,375.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$64.82
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP DNSP |
$41.82
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
OP
|
$2,486.02
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$2,486.02 |
| Rate for Payer: Aetna Commercial |
$2,237.41
|
| Rate for Payer: Aetna Medicare |
$41.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: ASR ASR |
$2,411.44
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.72
|
| Rate for Payer: BCN Commercial |
$2,049.72
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$1,988.81
|
| Rate for Payer: Cash Price |
$1,988.81
|
| Rate for Payer: Cofinity Commercial |
$2,336.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,988.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$2,411.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,486.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.82
|
| Rate for Payer: Mclaren Commercial |
$2,237.41
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$22.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,113.11
|
| Rate for Payer: Nomi Health Commercial |
$2,038.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,864.51
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicaid |
$22.42
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.22
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health Narrow Network |
$37.78
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,187.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$64.82
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP DNSP |
$41.82
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS AUTO-INJECTOR
|
Facility
|
IP
|
$2,486.02
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
206402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,864.51 |
| Max. Negotiated Rate |
$2,486.02 |
| Rate for Payer: Aetna Commercial |
$2,237.41
|
| Rate for Payer: ASR ASR |
$2,411.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,041.52
|
| Rate for Payer: BCN Commercial |
$2,041.52
|
| Rate for Payer: Cash Price |
$1,988.81
|
| Rate for Payer: Cofinity Commercial |
$2,336.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,988.81
|
| Rate for Payer: Healthscope Commercial |
$2,411.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,486.02
|
| Rate for Payer: Mclaren Commercial |
$2,237.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,113.11
|
| Rate for Payer: Nomi Health Commercial |
$2,038.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,864.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,187.69
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$2,265.79
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$2,265.79 |
| Rate for Payer: Aetna Commercial |
$2,039.21
|
| Rate for Payer: Aetna Medicare |
$41.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.27
|
| Rate for Payer: ASR ASR |
$2,197.82
|
| Rate for Payer: BCBS Complete |
$22.97
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,868.15
|
| Rate for Payer: BCN Commercial |
$1,868.15
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$1,812.63
|
| Rate for Payer: Cash Price |
$1,812.63
|
| Rate for Payer: Cofinity Commercial |
$2,129.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$2,197.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,265.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$41.82
|
| Rate for Payer: Mclaren Commercial |
$2,039.21
|
| Rate for Payer: Mclaren Medicaid |
$41.82
|
| Rate for Payer: Mclaren Medicare |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Meridian Medicaid |
$22.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.92
|
| Rate for Payer: Nomi Health Commercial |
$1,857.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.34
|
| Rate for Payer: PACE Medicare |
$39.73
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$46.00
|
| Rate for Payer: PHP Medicaid |
$22.42
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.22
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Priority Health Narrow Network |
$37.78
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,993.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$64.82
|
| Rate for Payer: UHC Medicaid |
$21.87
|
| Rate for Payer: UHCCP DNSP |
$41.82
|
| Rate for Payer: UHCCP Medicaid |
$21.87
|
| Rate for Payer: VA VA |
$41.82
|
|
|
OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$2,265.79
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
188926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,699.34 |
| Max. Negotiated Rate |
$2,265.79 |
| Rate for Payer: Aetna Commercial |
$2,039.21
|
| Rate for Payer: ASR ASR |
$2,197.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,860.67
|
| Rate for Payer: BCN Commercial |
$1,860.67
|
| Rate for Payer: Cash Price |
$1,812.63
|
| Rate for Payer: Cofinity Commercial |
$2,129.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,812.63
|
| Rate for Payer: Healthscope Commercial |
$2,197.82
|
| Rate for Payer: Healthscope Whirlpool |
$2,265.79
|
| Rate for Payer: Mclaren Commercial |
$2,039.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,925.92
|
| Rate for Payer: Nomi Health Commercial |
$1,857.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,993.90
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$495.43
|
|
|
Service Code
|
NDC 904749506
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.31 |
| Max. Negotiated Rate |
$495.43 |
| Rate for Payer: Aetna Commercial |
$445.89
|
| Rate for Payer: Aetna Medicare |
$183.31
|
| Rate for Payer: ASR ASR |
$480.57
|
| Rate for Payer: BCBS Complete |
$198.17
|
| Rate for Payer: BCBS Trust/PPO |
$408.48
|
| Rate for Payer: BCN Commercial |
$408.48
|
| Rate for Payer: Cash Price |
$396.34
|
| Rate for Payer: Cofinity Commercial |
$465.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.34
|
| Rate for Payer: Healthscope Commercial |
$480.57
|
| Rate for Payer: Healthscope Whirlpool |
$495.43
|
| Rate for Payer: Mclaren Commercial |
$445.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.12
|
| Rate for Payer: Nomi Health Commercial |
$406.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$371.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$434.10
|
| Rate for Payer: Priority Health Narrow Network |
$347.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$435.98
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$485.07
|
|
|
Service Code
|
NDC 60687012765
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$485.07 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: ASR ASR |
$470.52
|
| Rate for Payer: BCBS Trust/PPO |
$398.34
|
| Rate for Payer: BCN Commercial |
$398.34
|
| Rate for Payer: Cash Price |
$388.06
|
| Rate for Payer: Cofinity Commercial |
$455.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$388.06
|
| Rate for Payer: Healthscope Commercial |
$470.52
|
| Rate for Payer: Healthscope Whirlpool |
$485.07
|
| Rate for Payer: Mclaren Commercial |
$436.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.31
|
| Rate for Payer: Nomi Health Commercial |
$397.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.86
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$440.86
|
|
|
Service Code
|
NDC 904670606
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.64 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna Commercial |
$396.77
|
| Rate for Payer: ASR ASR |
$427.63
|
| Rate for Payer: BCBS Trust/PPO |
$362.03
|
| Rate for Payer: BCN Commercial |
$362.03
|
| Rate for Payer: Cash Price |
$352.68
|
| Rate for Payer: Cofinity Commercial |
$414.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.68
|
| Rate for Payer: Healthscope Commercial |
$427.63
|
| Rate for Payer: Healthscope Whirlpool |
$440.86
|
| Rate for Payer: Mclaren Commercial |
$396.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.73
|
| Rate for Payer: Nomi Health Commercial |
$361.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.95
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$493.50
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$370.12 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna Commercial |
$444.15
|
| Rate for Payer: ASR ASR |
$478.69
|
| Rate for Payer: BCBS Trust/PPO |
$405.26
|
| Rate for Payer: BCN Commercial |
$405.26
|
| Rate for Payer: Cash Price |
$394.80
|
| Rate for Payer: Cofinity Commercial |
$463.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.80
|
| Rate for Payer: Healthscope Commercial |
$478.69
|
| Rate for Payer: Healthscope Whirlpool |
$493.50
|
| Rate for Payer: Mclaren Commercial |
$444.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.48
|
| Rate for Payer: Nomi Health Commercial |
$404.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$370.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.28
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$440.86
|
|
|
Service Code
|
NDC 904670606
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.12 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna Commercial |
$396.77
|
| Rate for Payer: Aetna Medicare |
$163.12
|
| Rate for Payer: ASR ASR |
$427.63
|
| Rate for Payer: BCBS Complete |
$176.34
|
| Rate for Payer: BCBS Trust/PPO |
$363.48
|
| Rate for Payer: BCN Commercial |
$363.48
|
| Rate for Payer: Cash Price |
$352.68
|
| Rate for Payer: Cofinity Commercial |
$414.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.68
|
| Rate for Payer: Healthscope Commercial |
$427.63
|
| Rate for Payer: Healthscope Whirlpool |
$440.86
|
| Rate for Payer: Mclaren Commercial |
$396.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.73
|
| Rate for Payer: Nomi Health Commercial |
$361.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$386.28
|
| Rate for Payer: Priority Health Narrow Network |
$309.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.95
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$9.70
|
|
|
Service Code
|
NDC 60687012711
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: ASR ASR |
$9.41
|
| Rate for Payer: BCBS Trust/PPO |
$7.97
|
| Rate for Payer: BCN Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$7.76
|
| Rate for Payer: Cofinity Commercial |
$9.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.76
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Healthscope Whirlpool |
$9.70
|
| Rate for Payer: Mclaren Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.25
|
| Rate for Payer: Nomi Health Commercial |
$7.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.54
|
|
