|
RIFAXIMIN 550 MG TABLET
|
Facility
|
OP
|
$11,916.96
|
|
|
Service Code
|
NDC 65649030302
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,683.37 |
| Max. Negotiated Rate |
$10,725.26 |
| Rate for Payer: Aetna Commercial |
$10,129.42
|
| Rate for Payer: Aetna Medicare |
$5,958.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,746.02
|
| Rate for Payer: BCBS Complete |
$4,766.78
|
| Rate for Payer: Cash Price |
$9,533.57
|
| Rate for Payer: Cofinity Advantage |
$8,341.87
|
| Rate for Payer: Cofinity Commercial |
$10,248.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,533.57
|
| Rate for Payer: Healthscope Commercial |
$10,725.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,533.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,129.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,937.72
|
| Rate for Payer: PHP Commercial |
$10,129.42
|
| Rate for Payer: Priority Health SBD |
$7,507.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,746.02
|
| Rate for Payer: UHC Core |
$6,208.74
|
| Rate for Payer: UHC Exchange |
$4,683.37
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
OP
|
$11,916.96
|
|
|
Service Code
|
NDC 65649030303
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,683.37 |
| Max. Negotiated Rate |
$10,725.26 |
| Rate for Payer: Aetna Commercial |
$10,129.42
|
| Rate for Payer: Aetna Medicare |
$5,958.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,746.02
|
| Rate for Payer: BCBS Complete |
$4,766.78
|
| Rate for Payer: Cash Price |
$9,533.57
|
| Rate for Payer: Cofinity Advantage |
$8,341.87
|
| Rate for Payer: Cofinity Commercial |
$10,248.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,533.57
|
| Rate for Payer: Healthscope Commercial |
$10,725.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,533.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,129.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,937.72
|
| Rate for Payer: PHP Commercial |
$10,129.42
|
| Rate for Payer: Priority Health SBD |
$7,507.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,746.02
|
| Rate for Payer: UHC Core |
$6,208.74
|
| Rate for Payer: UHC Exchange |
$4,683.37
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,334.34
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
200582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$25,500.91 |
| Rate for Payer: Aetna Commercial |
$24,084.19
|
| Rate for Payer: Aetna Medicare |
$15.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,417.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.25
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS MAPPO |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$37.45
|
| Rate for Payer: BCN Commercial |
$37.45
|
| Rate for Payer: BCN Medicare Advantage |
$14.60
|
| Rate for Payer: Cash Price |
$22,667.47
|
| Rate for Payer: Cash Price |
$22,667.47
|
| Rate for Payer: Cofinity Advantage |
$19,834.04
|
| Rate for Payer: Cofinity Commercial |
$24,367.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,667.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.60
|
| Rate for Payer: Healthscope Commercial |
$25,500.91
|
| Rate for Payer: Mclaren Medicaid |
$7.64
|
| Rate for Payer: Mclaren Medicare |
$14.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.33
|
| Rate for Payer: Meridian Medicaid |
$15.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,084.19
|
| Rate for Payer: Nomi Health Commercial |
$43.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,250.76
|
| Rate for Payer: PACE Medicare |
$13.87
|
| Rate for Payer: PACE SWMI |
$14.60
|
| Rate for Payer: PHP Commercial |
$24,084.19
|
| Rate for Payer: PHP Medicare Advantage |
$14.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.11
|
| Rate for Payer: Priority Health Medicare |
$14.60
|
| Rate for Payer: Priority Health SBD |
$17,850.63
|
| Rate for Payer: Priority Health Tiered Network |
$37.69
|
| Rate for Payer: Railroad Medicare Medicare |
$14.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.63
|
| Rate for Payer: UHC Core |
$24.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.60
|
| Rate for Payer: UHC Exchange |
$24.63
|
| Rate for Payer: UHC Medicaid |
$7.64
|
| Rate for Payer: UHCCP Medicaid |
$7.64
|
| Rate for Payer: VA VA |
$14.60
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28,334.34
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
200582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,850.63 |
| Max. Negotiated Rate |
$25,500.91 |
| Rate for Payer: Aetna Commercial |
$24,084.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,417.32
|
| Rate for Payer: Cash Price |
$22,667.47
|
| Rate for Payer: Cofinity Advantage |
$19,834.04
|
| Rate for Payer: Cofinity Commercial |
$24,367.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,667.47
|
| Rate for Payer: Healthscope Commercial |
$25,500.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,084.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21,250.76
|
| Rate for Payer: PHP Commercial |
$24,084.19
|
| Rate for Payer: Priority Health SBD |
$17,850.63
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$460.60
|
|
|
Service Code
|
NDC 68084027001
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.18 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna Commercial |
$391.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.39
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: Cofinity Advantage |
$322.42
|
| Rate for Payer: Cofinity Commercial |
$396.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.48
|
| Rate for Payer: Healthscope Commercial |
$414.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.45
|
| Rate for Payer: PHP Commercial |
$391.51
|
| Rate for Payer: Priority Health SBD |
$290.18
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$460.60
|
|
|
Service Code
|
NDC 68084027001
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.02 |
| Max. Negotiated Rate |
$414.54 |
| Rate for Payer: Aetna Commercial |
$391.51
|
| Rate for Payer: Aetna Medicare |
$230.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.39
|
| Rate for Payer: BCBS Complete |
$184.24
|
| Rate for Payer: Cash Price |
$368.48
|
| Rate for Payer: Cofinity Advantage |
$322.42
|
| Rate for Payer: Cofinity Commercial |
$396.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$368.48
|
| Rate for Payer: Healthscope Commercial |
$414.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$368.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$345.45
|
| Rate for Payer: PHP Commercial |
$391.51
|
| Rate for Payer: Priority Health SBD |
$290.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$299.39
|
| Rate for Payer: UHC Core |
$239.97
|
| Rate for Payer: UHC Exchange |
$181.02
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$1.81
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 68084027101
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.25 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.81
|
| Rate for Payer: UHC Core |
$236.30
|
| Rate for Payer: UHC Exchange |
$178.25
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
IP
|
$229.90
|
|
|
Service Code
|
NDC 00904736161
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Advantage |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.43
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health SBD |
$144.84
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 68084027101
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.74 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 00904635861
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Aetna Medicare |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Advantage |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$319.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.62
|
| Rate for Payer: PHP Commercial |
$339.57
|
| Rate for Payer: Priority Health SBD |
$251.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.68
|
| Rate for Payer: UHC Core |
$208.14
|
| Rate for Payer: UHC Exchange |
$157.00
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
OP
|
$229.90
|
|
|
Service Code
|
NDC 00904736161
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$206.91 |
| Rate for Payer: Aetna Commercial |
$195.41
|
| Rate for Payer: Aetna Medicare |
$114.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.44
|
| Rate for Payer: BCBS Complete |
$91.96
|
| Rate for Payer: Cash Price |
$183.92
|
| Rate for Payer: Cofinity Advantage |
$160.93
|
| Rate for Payer: Cofinity Commercial |
$197.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.92
|
| Rate for Payer: Healthscope Commercial |
$206.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.43
|
| Rate for Payer: PHP Commercial |
$195.41
|
| Rate for Payer: Priority Health SBD |
$144.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.44
|
| Rate for Payer: UHC Core |
$119.78
|
| Rate for Payer: UHC Exchange |
$90.35
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
NDC 68084027111
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: BCBS Complete |
$1.82
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cofinity Advantage |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health SBD |
$2.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.95
|
| Rate for Payer: UHC Core |
$2.37
|
| Rate for Payer: UHC Exchange |
$1.78
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
IP
|
$4.54
|
|
|
Service Code
|
NDC 68084027111
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.95
|
| Rate for Payer: Cash Price |
$3.63
|
| Rate for Payer: Cofinity Advantage |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.63
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.86
|
| Rate for Payer: Priority Health SBD |
$2.86
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 00904635861
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.69 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Advantage |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$299.62
|
| Rate for Payer: PHP Commercial |
$339.57
|
| Rate for Payer: Priority Health SBD |
$251.69
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$393.58
|
|
|
Service Code
|
NDC 49884031591
|
| Hospital Charge Code |
35687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.96 |
| Max. Negotiated Rate |
$354.22 |
| Rate for Payer: Aetna Commercial |
$334.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.83
|
| Rate for Payer: Cash Price |
$314.86
|
| Rate for Payer: Cofinity Advantage |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$338.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.86
|
| Rate for Payer: Healthscope Commercial |
$354.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.19
|
| Rate for Payer: PHP Commercial |
$334.54
|
| Rate for Payer: Priority Health SBD |
$247.96
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$14.06
|
|
|
Service Code
|
NDC 49884031552
|
| Hospital Charge Code |
35687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.14
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cofinity Advantage |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$12.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.54
|
| Rate for Payer: PHP Commercial |
$11.95
|
| Rate for Payer: Priority Health SBD |
$8.86
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$14.06
|
|
|
Service Code
|
NDC 49884031552
|
| Hospital Charge Code |
35687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna Medicare |
$7.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.14
|
| Rate for Payer: BCBS Complete |
$5.62
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cofinity Advantage |
$9.84
|
| Rate for Payer: Cofinity Commercial |
$12.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.54
|
| Rate for Payer: PHP Commercial |
$11.95
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.14
|
| Rate for Payer: UHC Core |
$7.33
|
| Rate for Payer: UHC Exchange |
$5.53
|
|
|
RISPERIDONE 1 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$393.58
|
|
|
Service Code
|
NDC 49884031591
|
| Hospital Charge Code |
35687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.68 |
| Max. Negotiated Rate |
$354.22 |
| Rate for Payer: Aetna Commercial |
$334.54
|
| Rate for Payer: Aetna Medicare |
$196.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.83
|
| Rate for Payer: BCBS Complete |
$157.43
|
| Rate for Payer: Cash Price |
$314.86
|
| Rate for Payer: Cofinity Advantage |
$275.51
|
| Rate for Payer: Cofinity Commercial |
$338.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.86
|
| Rate for Payer: Healthscope Commercial |
$354.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$314.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.19
|
| Rate for Payer: PHP Commercial |
$334.54
|
| Rate for Payer: Priority Health SBD |
$247.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.83
|
| Rate for Payer: UHC Core |
$205.06
|
| Rate for Payer: UHC Exchange |
$154.68
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.68 |
| Max. Negotiated Rate |
$377.13 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna Medicare |
$209.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.37
|
| Rate for Payer: BCBS Complete |
$167.61
|
| Rate for Payer: Cash Price |
$335.22
|
| Rate for Payer: Cofinity Advantage |
$293.32
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.22
|
| Rate for Payer: Healthscope Commercial |
$377.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.27
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health SBD |
$263.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.37
|
| Rate for Payer: UHC Core |
$218.31
|
| Rate for Payer: UHC Exchange |
$164.68
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$133.92
|
|
|
Service Code
|
NDC 00054006344
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna Medicare |
$66.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: BCBS Complete |
$53.57
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Advantage |
$93.74
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.44
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.05
|
| Rate for Payer: UHC Core |
$69.77
|
| Rate for Payer: UHC Exchange |
$52.63
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$377.13 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.37
|
| Rate for Payer: Cash Price |
$335.22
|
| Rate for Payer: Cofinity Advantage |
$293.32
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.22
|
| Rate for Payer: Healthscope Commercial |
$377.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.27
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health SBD |
$263.99
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$134.64
|
|
|
Service Code
|
NDC 23155031751
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna Medicare |
$67.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: BCBS Complete |
$53.86
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Advantage |
$94.25
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.98
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health SBD |
$84.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.52
|
| Rate for Payer: UHC Core |
$70.15
|
| Rate for Payer: UHC Exchange |
$52.91
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.06 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Advantage |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.31
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health SBD |
$59.06
|
|
