|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.22 |
| Max. Negotiated Rate |
$265.55 |
| Rate for Payer: Aetna Commercial |
$239.00
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: ASR ASR |
$257.58
|
| Rate for Payer: ASR Commercial |
$257.58
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: BCBS Trust/PPO |
$217.46
|
| Rate for Payer: BCN Commercial |
$205.88
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Commercial |
$249.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$265.55
|
| Rate for Payer: Healthscope Whirlpool |
$257.58
|
| Rate for Payer: Mclaren Commercial |
$239.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Nomi Health Commercial |
$217.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.67
|
| Rate for Payer: Priority Health Narrow Network |
$186.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.68
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.58 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: ASR ASR |
$296.34
|
| Rate for Payer: ASR Commercial |
$296.34
|
| Rate for Payer: BCBS Trust/PPO |
$248.95
|
| Rate for Payer: BCN Commercial |
$236.85
|
| 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 |
$305.50
|
| Rate for Payer: Healthscope Whirlpool |
$296.34
|
| 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: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
OLANZAPINE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 60505311100
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: ASR ASR |
$296.34
|
| Rate for Payer: ASR Commercial |
$296.34
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: BCBS Trust/PPO |
$250.17
|
| Rate for Payer: BCN Commercial |
$236.85
|
| 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 |
$305.50
|
| Rate for Payer: Healthscope Whirlpool |
$296.34
|
| 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: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: 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
|
$1,625.93
|
|
|
Service Code
|
NDC 00002411530
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$650.37 |
| Max. Negotiated Rate |
$1,625.93 |
| Rate for Payer: Aetna Commercial |
$1,463.34
|
| Rate for Payer: Aetna Medicare |
$812.96
|
| Rate for Payer: ASR ASR |
$1,577.15
|
| Rate for Payer: ASR Commercial |
$1,577.15
|
| Rate for Payer: BCBS Complete |
$650.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.47
|
| Rate for Payer: BCN Commercial |
$1,260.58
|
| 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 |
$1,625.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,577.15
|
| 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: Priority Health Cigna Priority Health |
$1,056.85
|
| Rate for Payer: 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
|
|
|
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 |
$20.24 |
| Max. Negotiated Rate |
$2,265.79 |
| Rate for Payer: Aetna Commercial |
$2,039.21
|
| Rate for Payer: Aetna Medicare |
$37.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.20
|
| Rate for Payer: ASR ASR |
$2,197.82
|
| Rate for Payer: ASR Commercial |
$2,197.82
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$37.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.46
|
| Rate for Payer: BCN Commercial |
$1,756.67
|
| Rate for Payer: BCN Medicare Advantage |
$37.76
|
| 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 |
$37.76
|
| Rate for Payer: Healthscope Commercial |
$2,265.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,197.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$37.76
|
| Rate for Payer: Mclaren Commercial |
$2,039.21
|
| 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 |
$1,925.92
|
| Rate for Payer: Nomi Health Commercial |
$1,857.95
|
| Rate for Payer: PACE Medicare |
$35.87
|
| Rate for Payer: PACE SWMI |
$37.76
|
| Rate for Payer: PHP Commercial |
$41.54
|
| Rate for Payer: PHP Medicaid |
$20.24
|
| 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 |
$1,472.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.63
|
| Rate for Payer: Priority Health Medicare |
$37.76
|
| Rate for Payer: Priority Health Narrow Network |
$33.30
|
| Rate for Payer: Railroad Medicare Medicare |
$37.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,993.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.76
|
| Rate for Payer: UHC Exchange |
$58.53
|
| Rate for Payer: UHC Medicare Advantage |
$37.76
|
| Rate for Payer: UHCCP DNSP |
$37.76
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
| Rate for Payer: VA VA |
$37.76
|
|
|
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 |
$1,472.76 |
| 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: ASR Commercial |
$2,197.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,846.39
|
| Rate for Payer: BCN Commercial |
$1,756.67
|
| 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 |
$2,265.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,197.82
|
| 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: Priority Health Cigna Priority Health |
$1,472.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,993.90
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$493.50
|
|
|
Service Code
|
NDC 60505317007
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna Commercial |
$444.15
|
| Rate for Payer: Aetna Medicare |
$246.75
|
| Rate for Payer: ASR ASR |
$478.70
|
| Rate for Payer: ASR Commercial |
$478.70
|
| Rate for Payer: BCBS Complete |
$197.40
|
| Rate for Payer: BCBS Trust/PPO |
$404.13
|
| Rate for Payer: BCN Commercial |
$382.61
|
| 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 |
$493.50
|
| Rate for Payer: Healthscope Whirlpool |
$478.70
|
| 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: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.40
|
| Rate for Payer: Priority Health Narrow Network |
$345.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.28
|
|
|
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 |
$315.30 |
| Max. Negotiated Rate |
$485.07 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: ASR ASR |
$470.52
|
| Rate for Payer: ASR Commercial |
$470.52
|
| Rate for Payer: BCBS Trust/PPO |
$395.28
|
| Rate for Payer: BCN Commercial |
$376.07
|
| 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 |
$485.07
|
| Rate for Payer: Healthscope Whirlpool |
$470.52
|
| 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: Priority Health Cigna Priority Health |
$315.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.86
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$440.86
|
|
|
Service Code
|
NDC 00904670606
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.34 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna Commercial |
$396.77
|
| Rate for Payer: Aetna Medicare |
$220.43
|
| Rate for Payer: ASR ASR |
$427.63
|
| Rate for Payer: ASR Commercial |
$427.63
|
| Rate for Payer: BCBS Complete |
$176.34
|
| Rate for Payer: BCBS Trust/PPO |
$361.02
|
| Rate for Payer: BCN Commercial |
$341.80
|
| Rate for Payer: Cash Price |
$352.68
|
| Rate for Payer: Cofinity Commercial |
$414.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.69
|
| Rate for Payer: Healthscope Commercial |
$440.86
|
| Rate for Payer: Healthscope Whirlpool |
$427.63
|
| Rate for Payer: Mclaren Commercial |
$396.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.73
|
| Rate for Payer: Nomi Health Commercial |
$361.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.56
|
| Rate for Payer: 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 |
$387.96
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$9.70
|
|
|
Service Code
|
NDC 60687012711
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Medicare |
$4.85
|
| Rate for Payer: ASR ASR |
$9.41
|
| Rate for Payer: ASR Commercial |
$9.41
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$7.94
|
| Rate for Payer: BCN Commercial |
$7.52
|
| 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 |
$9.70
|
| Rate for Payer: Healthscope Whirlpool |
$9.41
|
| Rate for Payer: Mclaren Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: Nomi Health Commercial |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.50
|
| Rate for Payer: Priority Health Narrow Network |
$6.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.54
|
|
|
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 |
$320.78 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: Aetna Commercial |
$444.15
|
| Rate for Payer: ASR ASR |
$478.70
|
| Rate for Payer: ASR Commercial |
$478.70
|
| Rate for Payer: BCBS Trust/PPO |
$402.15
|
| Rate for Payer: BCN Commercial |
$382.61
|
| 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 |
$493.50
|
| Rate for Payer: Healthscope Whirlpool |
$478.70
|
| 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: Priority Health Cigna Priority Health |
$320.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$434.28
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
IP
|
$440.86
|
|
|
Service Code
|
NDC 00904670606
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$440.86 |
| Rate for Payer: Aetna Commercial |
$396.77
|
| Rate for Payer: ASR ASR |
$427.63
|
| Rate for Payer: ASR Commercial |
$427.63
|
| Rate for Payer: BCBS Trust/PPO |
$359.26
|
| Rate for Payer: BCN Commercial |
$341.80
|
| Rate for Payer: Cash Price |
$352.68
|
| Rate for Payer: Cofinity Commercial |
$414.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.69
|
| Rate for Payer: Healthscope Commercial |
$440.86
|
| Rate for Payer: Healthscope Whirlpool |
$427.63
|
| Rate for Payer: Mclaren Commercial |
$396.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.73
|
| Rate for Payer: Nomi Health Commercial |
$361.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$387.96
|
|
|
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 |
$6.30 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: ASR ASR |
$9.41
|
| Rate for Payer: ASR Commercial |
$9.41
|
| Rate for Payer: BCBS Trust/PPO |
$7.90
|
| Rate for Payer: BCN Commercial |
$7.52
|
| 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 |
$9.70
|
| Rate for Payer: Healthscope Whirlpool |
$9.41
|
| Rate for Payer: Mclaren Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.24
|
| Rate for Payer: Nomi Health Commercial |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.54
|
|
|
OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE
|
Facility
|
OP
|
$485.07
|
|
|
Service Code
|
NDC 60687012765
|
| Hospital Charge Code |
41822
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.03 |
| Max. Negotiated Rate |
$485.07 |
| Rate for Payer: Aetna Commercial |
$436.56
|
| Rate for Payer: Aetna Medicare |
$242.54
|
| Rate for Payer: ASR ASR |
$470.52
|
| Rate for Payer: ASR Commercial |
$470.52
|
| Rate for Payer: BCBS Complete |
$194.03
|
| Rate for Payer: BCBS Trust/PPO |
$397.22
|
| Rate for Payer: BCN Commercial |
$376.07
|
| 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 |
$485.07
|
| Rate for Payer: Healthscope Whirlpool |
$470.52
|
| 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: Priority Health Cigna Priority Health |
$315.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$425.02
|
| Rate for Payer: Priority Health Narrow Network |
$340.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.86
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$4.58
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: Aetna Medicare |
$2.29
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: BCBS Complete |
$1.83
|
| Rate for Payer: BCBS Trust/PPO |
$3.75
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.01
|
| Rate for Payer: Priority Health Narrow Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$83.66
|
|
|
Service Code
|
NDC 65862039010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.38 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$75.29
|
| Rate for Payer: ASR ASR |
$81.15
|
| Rate for Payer: ASR Commercial |
$81.15
|
| Rate for Payer: BCBS Trust/PPO |
$68.17
|
| Rate for Payer: BCN Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$66.93
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.93
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Healthscope Whirlpool |
$81.15
|
| Rate for Payer: Mclaren Commercial |
$75.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.11
|
| Rate for Payer: Nomi Health Commercial |
$68.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$66.40
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$33.20
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: ASR Commercial |
$64.41
|
| Rate for Payer: BCBS Complete |
$26.56
|
| Rate for Payer: BCBS Trust/PPO |
$54.37
|
| Rate for Payer: BCN Commercial |
$51.48
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: Nomi Health Commercial |
$54.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.18
|
| Rate for Payer: Priority Health Narrow Network |
$46.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.43
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$83.66
|
|
|
Service Code
|
NDC 65862039010
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.46 |
| Max. Negotiated Rate |
$83.66 |
| Rate for Payer: Aetna Commercial |
$75.29
|
| Rate for Payer: Aetna Medicare |
$41.83
|
| Rate for Payer: ASR ASR |
$81.15
|
| Rate for Payer: ASR Commercial |
$81.15
|
| Rate for Payer: BCBS Complete |
$33.46
|
| Rate for Payer: BCBS Trust/PPO |
$68.51
|
| Rate for Payer: BCN Commercial |
$64.86
|
| Rate for Payer: Cash Price |
$66.93
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.93
|
| Rate for Payer: Healthscope Commercial |
$83.66
|
| Rate for Payer: Healthscope Whirlpool |
$81.15
|
| Rate for Payer: Mclaren Commercial |
$75.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.11
|
| Rate for Payer: Nomi Health Commercial |
$68.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.30
|
| Rate for Payer: Priority Health Narrow Network |
$58.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.62
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$4.58
|
|
|
Service Code
|
NDC 68462015740
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.12
|
| Rate for Payer: ASR ASR |
$4.44
|
| Rate for Payer: ASR Commercial |
$4.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.73
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.66
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Healthscope Whirlpool |
$4.44
|
| Rate for Payer: Mclaren Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.89
|
| Rate for Payer: Nomi Health Commercial |
$3.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.03
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$66.40
|
|
|
Service Code
|
NDC 57237007710
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$66.40 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: ASR ASR |
$64.41
|
| Rate for Payer: ASR Commercial |
$64.41
|
| Rate for Payer: BCBS Trust/PPO |
$54.11
|
| Rate for Payer: BCN Commercial |
$51.48
|
| Rate for Payer: Cash Price |
$53.12
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$66.40
|
| Rate for Payer: Healthscope Whirlpool |
$64.41
|
| Rate for Payer: Mclaren Commercial |
$59.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.44
|
| Rate for Payer: Nomi Health Commercial |
$54.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.43
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$137.48
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$137.48 |
| Rate for Payer: Aetna Commercial |
$123.73
|
| Rate for Payer: Aetna Medicare |
$68.74
|
| Rate for Payer: ASR ASR |
$133.36
|
| Rate for Payer: ASR Commercial |
$133.36
|
| Rate for Payer: BCBS Complete |
$54.99
|
| Rate for Payer: BCBS Trust/PPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$106.59
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$137.48
|
| Rate for Payer: Healthscope Whirlpool |
$133.36
|
| Rate for Payer: Mclaren Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: Nomi Health Commercial |
$112.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.46
|
| Rate for Payer: Priority Health Narrow Network |
$96.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.98
|
|
|
ONDANSETRON 4 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$137.48
|
|
|
Service Code
|
NDC 68462015713
|
| Hospital Charge Code |
27697
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$137.48 |
| Rate for Payer: Aetna Commercial |
$123.73
|
| Rate for Payer: ASR ASR |
$133.36
|
| Rate for Payer: ASR Commercial |
$133.36
|
| Rate for Payer: BCBS Trust/PPO |
$112.03
|
| Rate for Payer: BCN Commercial |
$106.59
|
| Rate for Payer: Cash Price |
$109.98
|
| Rate for Payer: Cofinity Commercial |
$129.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$137.48
|
| Rate for Payer: Healthscope Whirlpool |
$133.36
|
| Rate for Payer: Mclaren Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.86
|
| Rate for Payer: Nomi Health Commercial |
$112.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.98
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$116.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$104.85
|
| Rate for Payer: Aetna Medicare |
$58.25
|
| Rate for Payer: ASR ASR |
$113.00
|
| Rate for Payer: ASR Commercial |
$113.00
|
| Rate for Payer: BCBS Complete |
$46.60
|
| Rate for Payer: BCBS Trust/PPO |
$95.40
|
| Rate for Payer: BCN Commercial |
$90.32
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Commercial |
$109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Healthscope Whirlpool |
$113.00
|
| Rate for Payer: Mclaren Commercial |
$104.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.02
|
| Rate for Payer: Nomi Health Commercial |
$95.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.52
|
|
|
ONDANSETRON HCL 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$116.50
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10777
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.72 |
| Max. Negotiated Rate |
$116.50 |
| Rate for Payer: Aetna Commercial |
$104.85
|
| Rate for Payer: ASR ASR |
$113.00
|
| Rate for Payer: ASR Commercial |
$113.00
|
| Rate for Payer: BCBS Trust/PPO |
$94.94
|
| Rate for Payer: BCN Commercial |
$90.32
|
| Rate for Payer: Cash Price |
$93.20
|
| Rate for Payer: Cofinity Commercial |
$109.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.20
|
| Rate for Payer: Healthscope Commercial |
$116.50
|
| Rate for Payer: Healthscope Whirlpool |
$113.00
|
| Rate for Payer: Mclaren Commercial |
$104.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.02
|
| Rate for Payer: Nomi Health Commercial |
$95.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.52
|
|
|
ONDANSETRON HCL 4 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$47.81
|
|
|
Service Code
|
NDC 00904707341
|
| Hospital Charge Code |
18877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: ASR ASR |
$46.38
|
| Rate for Payer: ASR Commercial |
$46.38
|
| Rate for Payer: BCBS Trust/PPO |
$38.96
|
| Rate for Payer: BCN Commercial |
$37.07
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$47.81
|
| Rate for Payer: Healthscope Whirlpool |
$46.38
|
| Rate for Payer: Mclaren Commercial |
$43.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.64
|
| Rate for Payer: Nomi Health Commercial |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.07
|
|
