|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$46.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: BCBS Complete |
$37.50
|
| 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: MI Amish Medical Board Commercial |
$75.00
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.94
|
| Rate for Payer: UHC Core |
$48.84
|
| Rate for Payer: UHC Exchange |
$36.84
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$133.92
|
|
|
Service Code
|
NDC 00054006344
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| 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: 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
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
NDC 23155031751
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| 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: 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
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 00904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Advantage |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health SBD |
$171.77
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$1,684.98
|
|
|
Service Code
|
NDC 50458030001
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$662.20 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna Medicare |
$842.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.24
|
| Rate for Payer: BCBS Complete |
$673.99
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Advantage |
$1,179.49
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,347.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.73
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health SBD |
$1,061.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.24
|
| Rate for Payer: UHC Core |
$877.87
|
| Rate for Payer: UHC Exchange |
$662.20
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$1,684.98
|
|
|
Service Code
|
NDC 50458030001
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,061.54 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.24
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Advantage |
$1,179.49
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.73
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health SBD |
$1,061.54
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.99 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.96
|
| Rate for Payer: UHC Core |
$176.31
|
| Rate for Payer: UHC Exchange |
$132.99
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.19 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 00904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.15 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna Medicare |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Advantage |
$190.85
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.49
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.22
|
| Rate for Payer: UHC Core |
$142.05
|
| Rate for Payer: UHC Exchange |
$107.15
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$122.71
|
|
|
Service Code
|
NDC 59746003022
|
| Hospital Charge Code |
35688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.31 |
| Max. Negotiated Rate |
$110.44 |
| Rate for Payer: Aetna Commercial |
$104.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.76
|
| Rate for Payer: Cash Price |
$98.17
|
| Rate for Payer: Cofinity Advantage |
$85.90
|
| Rate for Payer: Cofinity Commercial |
$105.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.17
|
| Rate for Payer: Healthscope Commercial |
$110.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.03
|
| Rate for Payer: PHP Commercial |
$104.30
|
| Rate for Payer: Priority Health SBD |
$77.31
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$122.71
|
|
|
Service Code
|
NDC 59746003022
|
| Hospital Charge Code |
35688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.23 |
| Max. Negotiated Rate |
$110.44 |
| Rate for Payer: Aetna Commercial |
$104.30
|
| Rate for Payer: Aetna Medicare |
$61.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.76
|
| Rate for Payer: BCBS Complete |
$49.08
|
| Rate for Payer: Cash Price |
$98.17
|
| Rate for Payer: Cofinity Advantage |
$85.90
|
| Rate for Payer: Cofinity Commercial |
$105.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.17
|
| Rate for Payer: Healthscope Commercial |
$110.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.03
|
| Rate for Payer: PHP Commercial |
$104.30
|
| Rate for Payer: Priority Health SBD |
$77.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.76
|
| Rate for Payer: UHC Core |
$63.93
|
| Rate for Payer: UHC Exchange |
$48.23
|
|
|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$190.99
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.32 |
| Max. Negotiated Rate |
$171.89 |
| Rate for Payer: Aetna Commercial |
$162.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.14
|
| Rate for Payer: Cash Price |
$152.79
|
| Rate for Payer: Cofinity Advantage |
$133.69
|
| Rate for Payer: Cofinity Commercial |
$164.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.79
|
| Rate for Payer: Healthscope Commercial |
$171.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.24
|
| Rate for Payer: PHP Commercial |
$162.34
|
| Rate for Payer: Priority Health SBD |
$120.32
|
|
|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$190.99
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.06 |
| Max. Negotiated Rate |
$171.89 |
| Rate for Payer: Aetna Commercial |
$162.34
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.14
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: Cash Price |
$152.79
|
| Rate for Payer: Cofinity Advantage |
$133.69
|
| Rate for Payer: Cofinity Commercial |
$164.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.79
|
| Rate for Payer: Healthscope Commercial |
$171.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.24
|
| Rate for Payer: PHP Commercial |
$162.34
|
| Rate for Payer: Priority Health SBD |
$120.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.14
|
| Rate for Payer: UHC Core |
$99.51
|
| Rate for Payer: UHC Exchange |
$75.06
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 00904636161
|
| Hospital Charge Code |
18312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.17 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
OP
|
$361.95
|
|
|
Service Code
|
NDC 00904736461
|
| Hospital Charge Code |
18312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.25 |
| Max. Negotiated Rate |
$325.75 |
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: Aetna Medicare |
$180.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.27
|
| Rate for Payer: BCBS Complete |
$144.78
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Advantage |
$253.37
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.46
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health SBD |
$228.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.27
|
| Rate for Payer: UHC Core |
$188.58
|
| Rate for Payer: UHC Exchange |
$142.25
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 00904636161
|
| Hospital Charge Code |
18312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.93 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna Medicare |
$200.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.20
|
| Rate for Payer: UHC Core |
$209.36
|
| Rate for Payer: UHC Exchange |
$157.93
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
IP
|
$361.95
|
|
|
Service Code
|
NDC 00904736461
|
| Hospital Charge Code |
18312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.03 |
| Max. Negotiated Rate |
$325.75 |
| Rate for Payer: Aetna Commercial |
$307.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.27
|
| Rate for Payer: Cash Price |
$289.56
|
| Rate for Payer: Cofinity Advantage |
$253.37
|
| Rate for Payer: Cofinity Commercial |
$311.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.56
|
| Rate for Payer: Healthscope Commercial |
$325.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.46
|
| Rate for Payer: PHP Commercial |
$307.66
|
| Rate for Payer: Priority Health SBD |
$228.03
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
IP
|
$927.74
|
|
|
Service Code
|
NDC 00074333330
|
| Hospital Charge Code |
100995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$584.48 |
| Max. Negotiated Rate |
$834.97 |
| Rate for Payer: Aetna Commercial |
$788.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.03
|
| Rate for Payer: Cash Price |
$742.19
|
| Rate for Payer: Cofinity Advantage |
$649.42
|
| Rate for Payer: Cofinity Commercial |
$797.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.19
|
| Rate for Payer: Healthscope Commercial |
$834.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.80
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health SBD |
$584.48
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
OP
|
$927.74
|
|
|
Service Code
|
NDC 00074333330
|
| Hospital Charge Code |
100995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$834.97 |
| Rate for Payer: Aetna Commercial |
$788.58
|
| Rate for Payer: Aetna Medicare |
$463.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.03
|
| Rate for Payer: BCBS Complete |
$371.10
|
| Rate for Payer: Cash Price |
$742.19
|
| Rate for Payer: Cofinity Advantage |
$649.42
|
| Rate for Payer: Cofinity Commercial |
$797.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.19
|
| Rate for Payer: Healthscope Commercial |
$834.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$742.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.80
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health SBD |
$584.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.03
|
| Rate for Payer: UHC Core |
$483.35
|
| Rate for Payer: UHC Exchange |
$364.60
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$21,092.23
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$18,983.01 |
| Rate for Payer: Aetna Commercial |
$17,928.40
|
| Rate for Payer: Aetna Commercial |
$3,585.68
|
| Rate for Payer: Aetna Medicare |
$77.13
|
| Rate for Payer: Aetna Medicare |
$77.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,741.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,709.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.70
|
| Rate for Payer: BCBS Complete |
$40.73
|
| Rate for Payer: BCBS Complete |
$40.73
|
| Rate for Payer: BCBS MAPPO |
$74.16
|
| Rate for Payer: BCBS MAPPO |
$74.16
|
| Rate for Payer: BCBS Trust/PPO |
$187.56
|
| Rate for Payer: BCBS Trust/PPO |
$187.56
|
| Rate for Payer: BCN Commercial |
$187.56
|
| Rate for Payer: BCN Commercial |
$187.56
|
| Rate for Payer: BCN Medicare Advantage |
$74.16
|
| Rate for Payer: BCN Medicare Advantage |
$74.16
|
| Rate for Payer: Cash Price |
$16,873.78
|
| Rate for Payer: Cash Price |
$3,374.76
|
| Rate for Payer: Cash Price |
$3,374.76
|
| Rate for Payer: Cash Price |
$16,873.78
|
| Rate for Payer: Cofinity Advantage |
$2,952.91
|
| Rate for Payer: Cofinity Advantage |
$14,764.56
|
| Rate for Payer: Cofinity Commercial |
$3,627.87
|
| Rate for Payer: Cofinity Commercial |
$18,139.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,873.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,374.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.16
|
| Rate for Payer: Healthscope Commercial |
$18,983.01
|
| Rate for Payer: Healthscope Commercial |
$3,796.61
|
| Rate for Payer: Mclaren Medicaid |
$38.79
|
| Rate for Payer: Mclaren Medicaid |
$38.79
|
| Rate for Payer: Mclaren Medicare |
$74.16
|
| Rate for Payer: Mclaren Medicare |
$74.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.87
|
| Rate for Payer: Meridian Medicaid |
$77.87
|
| Rate for Payer: Meridian Medicaid |
$77.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,928.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.68
|
| Rate for Payer: Nomi Health Commercial |
$222.48
|
| Rate for Payer: Nomi Health Commercial |
$222.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,819.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,163.84
|
| Rate for Payer: PACE Medicare |
$70.45
|
| Rate for Payer: PACE Medicare |
$70.45
|
| Rate for Payer: PACE SWMI |
$74.16
|
| Rate for Payer: PACE SWMI |
$74.16
|
| Rate for Payer: PHP Commercial |
$3,585.68
|
| Rate for Payer: PHP Commercial |
$17,928.40
|
| Rate for Payer: PHP Medicare Advantage |
$74.16
|
| Rate for Payer: PHP Medicare Advantage |
$74.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$237.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$237.23
|
| Rate for Payer: Priority Health Medicare |
$74.16
|
| Rate for Payer: Priority Health Medicare |
$74.16
|
| Rate for Payer: Priority Health SBD |
$2,657.62
|
| Rate for Payer: Priority Health SBD |
$13,288.10
|
| Rate for Payer: Priority Health Tiered Network |
$189.78
|
| Rate for Payer: Priority Health Tiered Network |
$189.78
|
| Rate for Payer: Railroad Medicare Medicare |
$74.16
|
| Rate for Payer: Railroad Medicare Medicare |
$74.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.37
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.16
|
| Rate for Payer: UHC Exchange |
$123.37
|
| Rate for Payer: UHC Exchange |
$123.37
|
| Rate for Payer: UHC Medicaid |
$38.79
|
| Rate for Payer: UHC Medicaid |
$38.79
|
| Rate for Payer: UHCCP Medicaid |
$38.79
|
| Rate for Payer: UHCCP Medicaid |
$38.79
|
| Rate for Payer: VA VA |
$74.16
|
| Rate for Payer: VA VA |
$74.16
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$21,092.23
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,288.10 |
| Max. Negotiated Rate |
$18,983.01 |
| Rate for Payer: Aetna Commercial |
$17,928.40
|
| Rate for Payer: Aetna Commercial |
$3,585.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,709.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,741.99
|
| Rate for Payer: Cash Price |
$16,873.78
|
| Rate for Payer: Cash Price |
$3,374.76
|
| Rate for Payer: Cofinity Advantage |
$14,764.56
|
| Rate for Payer: Cofinity Advantage |
$2,952.91
|
| Rate for Payer: Cofinity Commercial |
$18,139.32
|
| Rate for Payer: Cofinity Commercial |
$3,627.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,374.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,873.78
|
| Rate for Payer: Healthscope Commercial |
$3,796.61
|
| Rate for Payer: Healthscope Commercial |
$18,983.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,928.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,819.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,163.84
|
| Rate for Payer: PHP Commercial |
$17,928.40
|
| Rate for Payer: PHP Commercial |
$3,585.68
|
| Rate for Payer: Priority Health SBD |
$13,288.10
|
| Rate for Payer: Priority Health SBD |
$2,657.62
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
IP
|
$17,099.12
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,772.45 |
| Max. Negotiated Rate |
$15,389.21 |
| Rate for Payer: Aetna Commercial |
$14,534.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,114.43
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cofinity Advantage |
$11,969.38
|
| Rate for Payer: Cofinity Commercial |
$14,705.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,679.30
|
| Rate for Payer: Healthscope Commercial |
$15,389.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,534.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,824.34
|
| Rate for Payer: PHP Commercial |
$14,534.25
|
| Rate for Payer: Priority Health SBD |
$10,772.45
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
OP
|
$17,099.12
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$15,389.21 |
| Rate for Payer: Aetna Commercial |
$14,534.25
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,114.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.35
|
| Rate for Payer: BCBS Complete |
$19.92
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS Trust/PPO |
$92.49
|
| Rate for Payer: BCN Commercial |
$92.49
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cofinity Advantage |
$11,969.38
|
| Rate for Payer: Cofinity Commercial |
$14,705.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,679.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$15,389.21
|
| Rate for Payer: Mclaren Medicaid |
$18.97
|
| Rate for Payer: Mclaren Medicare |
$36.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Medicaid |
$38.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,534.25
|
| Rate for Payer: Nomi Health Commercial |
$108.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,824.34
|
| Rate for Payer: PACE Medicare |
$34.47
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Commercial |
$14,534.25
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.73
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health SBD |
$10,772.45
|
| Rate for Payer: Priority Health Tiered Network |
$92.58
|
| Rate for Payer: Railroad Medicare Medicare |
$36.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.84
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.28
|
| Rate for Payer: UHC Exchange |
$60.84
|
| Rate for Payer: UHC Medicaid |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$18.97
|
| Rate for Payer: VA VA |
$36.28
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13,325.88
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,395.30 |
| Max. Negotiated Rate |
$11,993.29 |
| Rate for Payer: Aetna Commercial |
$11,327.00
|
| Rate for Payer: Aetna Commercial |
$2,265.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,661.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.37
|
| Rate for Payer: Cash Price |
$10,660.70
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Advantage |
$9,328.12
|
| Rate for Payer: Cofinity Advantage |
$1,865.63
|
| Rate for Payer: Cofinity Commercial |
$11,460.26
|
| Rate for Payer: Cofinity Commercial |
$2,292.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,660.70
|
| Rate for Payer: Healthscope Commercial |
$2,398.66
|
| Rate for Payer: Healthscope Commercial |
$11,993.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,327.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,994.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.88
|
| Rate for Payer: PHP Commercial |
$11,327.00
|
| Rate for Payer: PHP Commercial |
$2,265.40
|
| Rate for Payer: Priority Health SBD |
$8,395.30
|
| Rate for Payer: Priority Health SBD |
$1,679.06
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$13,325.88
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$11,993.29 |
| Rate for Payer: Aetna Commercial |
$11,327.00
|
| Rate for Payer: Aetna Commercial |
$2,265.40
|
| Rate for Payer: Aetna Medicare |
$32.53
|
| Rate for Payer: Aetna Medicare |
$32.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,661.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.10
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$108.05
|
| Rate for Payer: BCBS Trust/PPO |
$108.05
|
| Rate for Payer: BCN Commercial |
$108.05
|
| Rate for Payer: BCN Commercial |
$108.05
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: Cash Price |
$10,660.70
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$10,660.70
|
| Rate for Payer: Cofinity Advantage |
$1,865.63
|
| Rate for Payer: Cofinity Advantage |
$9,328.12
|
| Rate for Payer: Cofinity Commercial |
$2,292.05
|
| Rate for Payer: Cofinity Commercial |
$11,460.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,660.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$11,993.29
|
| Rate for Payer: Healthscope Commercial |
$2,398.66
|
| Rate for Payer: Mclaren Medicaid |
$16.36
|
| Rate for Payer: Mclaren Medicaid |
$16.36
|
| Rate for Payer: Mclaren Medicare |
$31.28
|
| Rate for Payer: Mclaren Medicare |
$31.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: Meridian Medicaid |
$32.84
|
| Rate for Payer: Meridian Medicaid |
$32.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,327.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,994.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.88
|
| Rate for Payer: PACE Medicare |
$29.72
|
| Rate for Payer: PACE Medicare |
$29.72
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PHP Commercial |
$2,265.40
|
| Rate for Payer: PHP Commercial |
$11,327.00
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health SBD |
$1,679.06
|
| Rate for Payer: Priority Health SBD |
$8,395.30
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$31.28
|
| Rate for Payer: Railroad Medicare Medicare |
$31.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.75
|
| Rate for Payer: UHC Core |
$49.75
|
| Rate for Payer: UHC Core |
$49.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.28
|
| Rate for Payer: UHC Exchange |
$49.75
|
| Rate for Payer: UHC Exchange |
$49.75
|
| Rate for Payer: UHC Medicaid |
$16.36
|
| Rate for Payer: UHC Medicaid |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: VA VA |
$31.28
|
| Rate for Payer: VA VA |
$31.28
|
|
