|
RADIOTHERAPY
|
Facility
|
IP
|
$4,624.24
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$4,404.04 |
| Max. Negotiated Rate |
$4,624.24 |
| Rate for Payer: BCBS Complete |
$4,624.24
|
| Rate for Payer: Mclaren Medicaid |
$4,404.04
|
| Rate for Payer: Meridian Medicaid |
$4,624.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,404.04
|
| Rate for Payer: UHC Medicaid |
$4,404.04
|
| Rate for Payer: UHCCP Medicaid |
$4,404.04
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$59,168.40
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$20,442.70 |
| Max. Negotiated Rate |
$59,168.40 |
| Rate for Payer: Aetna Medicare |
$22,379.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,898.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,898.29
|
| Rate for Payer: BCBS MAPPO |
$21,518.63
|
| Rate for Payer: BCBS Trust/PPO |
$59,168.40
|
| Rate for Payer: BCN Commercial |
$59,168.40
|
| Rate for Payer: BCN Medicare Advantage |
$21,518.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,518.63
|
| Rate for Payer: Mclaren Medicare |
$21,518.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,594.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,746.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,670.49
|
| Rate for Payer: Nomi Health Commercial |
$34,952.55
|
| Rate for Payer: PACE Medicare |
$20,442.70
|
| Rate for Payer: PACE SWMI |
$21,518.63
|
| Rate for Payer: PHP Medicare Advantage |
$21,518.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,682.94
|
| Rate for Payer: Priority Health Medicare |
$21,518.63
|
| Rate for Payer: Priority Health Tiered Network |
$34,946.35
|
| Rate for Payer: Railroad Medicare Medicare |
$21,518.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,164.85
|
| Rate for Payer: UHC Core |
$36,949.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,518.63
|
| Rate for Payer: UHC Exchange |
$30,175.70
|
| Rate for Payer: VA VA |
$21,518.63
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$20,298.26
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$19,331.68 |
| Max. Negotiated Rate |
$20,298.26 |
| Rate for Payer: BCBS Complete |
$20,298.26
|
| Rate for Payer: Mclaren Medicaid |
$19,331.68
|
| Rate for Payer: Meridian Medicaid |
$20,298.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,331.68
|
| Rate for Payer: UHC Medicaid |
$19,331.68
|
| Rate for Payer: UHCCP Medicaid |
$19,331.68
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$15,383.36
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$14,650.82 |
| Max. Negotiated Rate |
$15,383.36 |
| Rate for Payer: BCBS Complete |
$15,383.36
|
| Rate for Payer: Mclaren Medicaid |
$14,650.82
|
| Rate for Payer: Meridian Medicaid |
$15,383.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,650.82
|
| Rate for Payer: UHC Medicaid |
$14,650.82
|
| Rate for Payer: UHCCP Medicaid |
$14,650.82
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$11,612.19
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$11,059.23 |
| Max. Negotiated Rate |
$11,612.19 |
| Rate for Payer: BCBS Complete |
$11,612.19
|
| Rate for Payer: Mclaren Medicaid |
$11,059.23
|
| Rate for Payer: Meridian Medicaid |
$11,612.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,059.23
|
| Rate for Payer: UHC Medicaid |
$11,059.23
|
| Rate for Payer: UHCCP Medicaid |
$11,059.23
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna Medicare |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$34.85
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Advantage |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.34
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.63
|
| Rate for Payer: UHC Core |
$45.39
|
| Rate for Payer: UHC Exchange |
$34.24
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$609.28
|
|
|
Service Code
|
NDC 60687026621
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.45 |
| Max. Negotiated Rate |
$548.35 |
| Rate for Payer: Aetna Commercial |
$517.89
|
| Rate for Payer: Aetna Medicare |
$304.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.03
|
| Rate for Payer: BCBS Complete |
$243.71
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cofinity Advantage |
$426.50
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$487.42
|
| Rate for Payer: Healthscope Commercial |
$548.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$487.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.96
|
| Rate for Payer: PHP Commercial |
$517.89
|
| Rate for Payer: Priority Health SBD |
$383.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.03
|
| Rate for Payer: UHC Core |
$317.43
|
| Rate for Payer: UHC Exchange |
$239.45
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$714.29
|
|
|
Service Code
|
NDC 00002418430
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.72 |
| Max. Negotiated Rate |
$642.86 |
| Rate for Payer: Aetna Commercial |
$607.15
|
| Rate for Payer: Aetna Medicare |
$357.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.29
|
| Rate for Payer: BCBS Complete |
$285.72
|
| Rate for Payer: Cash Price |
$571.43
|
| Rate for Payer: Cofinity Advantage |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$614.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.43
|
| Rate for Payer: Healthscope Commercial |
$642.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.72
|
| Rate for Payer: PHP Commercial |
$607.15
|
| Rate for Payer: Priority Health SBD |
$450.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.29
|
| Rate for Payer: UHC Core |
$372.15
|
| Rate for Payer: UHC Exchange |
$280.72
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
NDC 50268069411
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.41
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cofinity Advantage |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.89
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: PHP Commercial |
$8.38
|
| Rate for Payer: Priority Health SBD |
$6.21
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Advantage |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.34
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health SBD |
$54.89
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$20.31
|
|
|
Service Code
|
NDC 60687026611
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$18.28 |
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cofinity Advantage |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.23
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: Priority Health SBD |
$12.80
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$609.28
|
|
|
Service Code
|
NDC 60687026621
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$383.85 |
| Max. Negotiated Rate |
$548.35 |
| Rate for Payer: Aetna Commercial |
$517.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.03
|
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Cofinity Advantage |
$426.50
|
| Rate for Payer: Cofinity Commercial |
$523.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$487.42
|
| Rate for Payer: Healthscope Commercial |
$548.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$517.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$456.96
|
| Rate for Payer: PHP Commercial |
$517.89
|
| Rate for Payer: Priority Health SBD |
$383.85
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$492.84
|
|
|
Service Code
|
NDC 50268069415
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.69 |
| Max. Negotiated Rate |
$443.56 |
| Rate for Payer: Aetna Commercial |
$418.91
|
| Rate for Payer: Aetna Medicare |
$246.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.35
|
| Rate for Payer: BCBS Complete |
$197.14
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cofinity Advantage |
$344.99
|
| Rate for Payer: Cofinity Commercial |
$423.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.27
|
| Rate for Payer: Healthscope Commercial |
$443.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$394.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.63
|
| Rate for Payer: PHP Commercial |
$418.91
|
| Rate for Payer: Priority Health SBD |
$310.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.35
|
| Rate for Payer: UHC Core |
$256.77
|
| Rate for Payer: UHC Exchange |
$193.69
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$492.84
|
|
|
Service Code
|
NDC 50268069415
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$310.49 |
| Max. Negotiated Rate |
$443.56 |
| Rate for Payer: Aetna Commercial |
$418.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.35
|
| Rate for Payer: Cash Price |
$394.27
|
| Rate for Payer: Cofinity Advantage |
$344.99
|
| Rate for Payer: Cofinity Commercial |
$423.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.27
|
| Rate for Payer: Healthscope Commercial |
$443.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$369.63
|
| Rate for Payer: PHP Commercial |
$418.91
|
| Rate for Payer: Priority Health SBD |
$310.49
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$20.31
|
|
|
Service Code
|
NDC 60687026611
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$18.28 |
| Rate for Payer: Aetna Commercial |
$17.26
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.20
|
| Rate for Payer: BCBS Complete |
$8.12
|
| Rate for Payer: Cash Price |
$16.25
|
| Rate for Payer: Cofinity Advantage |
$14.22
|
| Rate for Payer: Cofinity Commercial |
$17.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.25
|
| Rate for Payer: Healthscope Commercial |
$18.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.23
|
| Rate for Payer: PHP Commercial |
$17.26
|
| Rate for Payer: Priority Health SBD |
$12.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.20
|
| Rate for Payer: UHC Core |
$10.58
|
| Rate for Payer: UHC Exchange |
$7.98
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
NDC 50268069411
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna Medicare |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.41
|
| Rate for Payer: BCBS Complete |
$3.94
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cofinity Advantage |
$6.90
|
| Rate for Payer: Cofinity Commercial |
$8.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.89
|
| Rate for Payer: Healthscope Commercial |
$8.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.39
|
| Rate for Payer: PHP Commercial |
$8.38
|
| Rate for Payer: Priority Health SBD |
$6.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.41
|
| Rate for Payer: UHC Core |
$5.14
|
| Rate for Payer: UHC Exchange |
$3.87
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$714.29
|
|
|
Service Code
|
NDC 00002418430
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$642.86 |
| Rate for Payer: Aetna Commercial |
$607.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.29
|
| Rate for Payer: Cash Price |
$571.43
|
| Rate for Payer: Cofinity Advantage |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$614.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$571.43
|
| Rate for Payer: Healthscope Commercial |
$642.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$607.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$535.72
|
| Rate for Payer: PHP Commercial |
$607.15
|
| Rate for Payer: Priority Health SBD |
$450.00
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,688.31
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,843.64 |
| Max. Negotiated Rate |
$6,919.48 |
| Rate for Payer: Aetna Commercial |
$6,535.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,997.40
|
| Rate for Payer: Cash Price |
$6,150.65
|
| Rate for Payer: Cofinity Advantage |
$5,381.82
|
| Rate for Payer: Cofinity Commercial |
$6,611.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.65
|
| Rate for Payer: Healthscope Commercial |
$6,919.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: PHP Commercial |
$6,535.06
|
| Rate for Payer: Priority Health SBD |
$4,843.64
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,688.31
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,021.51 |
| Max. Negotiated Rate |
$6,919.48 |
| Rate for Payer: Aetna Commercial |
$6,535.06
|
| Rate for Payer: Aetna Medicare |
$3,844.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,997.40
|
| Rate for Payer: BCBS Complete |
$3,075.32
|
| Rate for Payer: Cash Price |
$6,150.65
|
| Rate for Payer: Cofinity Advantage |
$5,381.82
|
| Rate for Payer: Cofinity Commercial |
$6,611.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.65
|
| Rate for Payer: Healthscope Commercial |
$6,919.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,150.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: PHP Commercial |
$6,535.06
|
| Rate for Payer: Priority Health SBD |
$4,843.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,997.40
|
| Rate for Payer: UHC Core |
$4,005.61
|
| Rate for Payer: UHC Exchange |
$3,021.51
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 65862047401
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.56
|
| Rate for Payer: UHC Core |
$91.83
|
| Rate for Payer: UHC Exchange |
$69.27
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 65862047401
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$158.62 |
| Rate for Payer: Aetna Commercial |
$149.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.56
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Advantage |
$123.38
|
| Rate for Payer: Cofinity Commercial |
$151.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: PHP Commercial |
$149.81
|
| Rate for Payer: Priority Health SBD |
$111.04
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.31 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$71.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.18
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Advantage |
$100.34
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health SBD |
$90.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.18
|
| Rate for Payer: UHC Core |
$74.69
|
| Rate for Payer: UHC Exchange |
$56.34
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,839.62
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,308.96 |
| Max. Negotiated Rate |
$6,155.66 |
| Rate for Payer: Aetna Commercial |
$5,813.68
|
| Rate for Payer: Aetna Commercial |
$29,068.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,228.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,445.75
|
| Rate for Payer: Cash Price |
$27,358.47
|
| Rate for Payer: Cash Price |
$5,471.70
|
| Rate for Payer: Cofinity Advantage |
$4,787.73
|
| Rate for Payer: Cofinity Advantage |
$23,938.66
|
| Rate for Payer: Cofinity Commercial |
$29,410.36
|
| Rate for Payer: Cofinity Commercial |
$5,882.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,358.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,471.70
|
| Rate for Payer: Healthscope Commercial |
$30,778.28
|
| Rate for Payer: Healthscope Commercial |
$6,155.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,813.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,068.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,129.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25,648.57
|
| Rate for Payer: PHP Commercial |
$29,068.38
|
| Rate for Payer: PHP Commercial |
$5,813.68
|
| Rate for Payer: Priority Health SBD |
$21,544.80
|
| Rate for Payer: Priority Health SBD |
$4,308.96
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,839.62
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.47 |
| Max. Negotiated Rate |
$6,155.66 |
| Rate for Payer: Aetna Commercial |
$5,813.68
|
| Rate for Payer: Aetna Commercial |
$29,068.38
|
| Rate for Payer: Aetna Medicare |
$78.49
|
| Rate for Payer: Aetna Medicare |
$78.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,228.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,445.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.34
|
| Rate for Payer: BCBS Complete |
$41.45
|
| Rate for Payer: BCBS Complete |
$41.45
|
| Rate for Payer: BCBS MAPPO |
$75.47
|
| Rate for Payer: BCBS MAPPO |
$75.47
|
| Rate for Payer: BCBS Trust/PPO |
$186.11
|
| Rate for Payer: BCBS Trust/PPO |
$186.11
|
| Rate for Payer: BCN Commercial |
$186.11
|
| Rate for Payer: BCN Commercial |
$186.11
|
| Rate for Payer: BCN Medicare Advantage |
$75.47
|
| Rate for Payer: BCN Medicare Advantage |
$75.47
|
| Rate for Payer: Cash Price |
$27,358.47
|
| Rate for Payer: Cash Price |
$27,358.47
|
| Rate for Payer: Cash Price |
$5,471.70
|
| Rate for Payer: Cash Price |
$5,471.70
|
| Rate for Payer: Cofinity Advantage |
$4,787.73
|
| Rate for Payer: Cofinity Advantage |
$23,938.66
|
| Rate for Payer: Cofinity Commercial |
$5,882.07
|
| Rate for Payer: Cofinity Commercial |
$29,410.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27,358.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,471.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.47
|
| Rate for Payer: Healthscope Commercial |
$30,778.28
|
| Rate for Payer: Healthscope Commercial |
$6,155.66
|
| Rate for Payer: Mclaren Medicaid |
$39.47
|
| Rate for Payer: Mclaren Medicaid |
$39.47
|
| Rate for Payer: Mclaren Medicare |
$75.47
|
| Rate for Payer: Mclaren Medicare |
$75.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.24
|
| Rate for Payer: Meridian Medicaid |
$79.24
|
| Rate for Payer: Meridian Medicaid |
$79.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,068.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,813.68
|
| Rate for Payer: Nomi Health Commercial |
$226.41
|
| Rate for Payer: Nomi Health Commercial |
$226.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,129.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25,648.57
|
| Rate for Payer: PACE Medicare |
$71.70
|
| Rate for Payer: PACE Medicare |
$71.70
|
| Rate for Payer: PACE SWMI |
$75.47
|
| Rate for Payer: PACE SWMI |
$75.47
|
| Rate for Payer: PHP Commercial |
$29,068.38
|
| Rate for Payer: PHP Commercial |
$5,813.68
|
| Rate for Payer: PHP Medicare Advantage |
$75.47
|
| Rate for Payer: PHP Medicare Advantage |
$75.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$234.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$234.52
|
| Rate for Payer: Priority Health Medicare |
$75.47
|
| Rate for Payer: Priority Health Medicare |
$75.47
|
| Rate for Payer: Priority Health SBD |
$4,308.96
|
| Rate for Payer: Priority Health SBD |
$21,544.80
|
| Rate for Payer: Priority Health Tiered Network |
$187.62
|
| Rate for Payer: Priority Health Tiered Network |
$187.62
|
| Rate for Payer: Railroad Medicare Medicare |
$75.47
|
| Rate for Payer: Railroad Medicare Medicare |
$75.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.71
|
| Rate for Payer: UHC Core |
$124.71
|
| Rate for Payer: UHC Core |
$124.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.47
|
| Rate for Payer: UHC Exchange |
$124.71
|
| Rate for Payer: UHC Exchange |
$124.71
|
| Rate for Payer: UHC Medicaid |
$39.47
|
| Rate for Payer: UHC Medicaid |
$39.47
|
| Rate for Payer: UHCCP Medicaid |
$39.47
|
| Rate for Payer: UHCCP Medicaid |
$39.47
|
| Rate for Payer: VA VA |
$75.47
|
| Rate for Payer: VA VA |
$75.47
|
|
