|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 60687078611
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Advantage |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.60
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health SBD |
$7.22
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$225.94
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.34 |
| Max. Negotiated Rate |
$203.35 |
| Rate for Payer: Aetna Commercial |
$192.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.86
|
| Rate for Payer: Cash Price |
$180.75
|
| Rate for Payer: Cofinity Advantage |
$158.16
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.75
|
| Rate for Payer: Healthscope Commercial |
$203.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.46
|
| Rate for Payer: PHP Commercial |
$192.05
|
| Rate for Payer: Priority Health SBD |
$142.34
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$81.36
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.26 |
| Max. Negotiated Rate |
$73.22 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.88
|
| Rate for Payer: Cash Price |
$65.09
|
| Rate for Payer: Cofinity Advantage |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.09
|
| Rate for Payer: Healthscope Commercial |
$73.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.02
|
| Rate for Payer: PHP Commercial |
$69.16
|
| Rate for Payer: Priority Health SBD |
$51.26
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$81.36
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$73.22 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Medicare |
$40.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.88
|
| Rate for Payer: BCBS Complete |
$32.54
|
| Rate for Payer: Cash Price |
$65.09
|
| Rate for Payer: Cofinity Advantage |
$56.95
|
| Rate for Payer: Cofinity Commercial |
$69.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.09
|
| Rate for Payer: Healthscope Commercial |
$73.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.02
|
| Rate for Payer: PHP Commercial |
$69.16
|
| Rate for Payer: Priority Health SBD |
$51.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.88
|
| Rate for Payer: UHC Core |
$42.39
|
| Rate for Payer: UHC Exchange |
$31.97
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$343.55
|
|
|
Service Code
|
NDC 60687078621
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.02 |
| Max. Negotiated Rate |
$309.19 |
| Rate for Payer: Aetna Commercial |
$292.02
|
| Rate for Payer: Aetna Medicare |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.31
|
| Rate for Payer: BCBS Complete |
$137.42
|
| Rate for Payer: Cash Price |
$274.84
|
| Rate for Payer: Cofinity Advantage |
$240.49
|
| Rate for Payer: Cofinity Commercial |
$295.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.84
|
| Rate for Payer: Healthscope Commercial |
$309.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.66
|
| Rate for Payer: PHP Commercial |
$292.02
|
| Rate for Payer: Priority Health SBD |
$216.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.31
|
| Rate for Payer: UHC Core |
$178.99
|
| Rate for Payer: UHC Exchange |
$135.02
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,528.81
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$963.15 |
| Max. Negotiated Rate |
$1,375.93 |
| Rate for Payer: Aetna Commercial |
$1,299.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.73
|
| Rate for Payer: Cash Price |
$1,223.05
|
| Rate for Payer: Cofinity Advantage |
$1,070.17
|
| Rate for Payer: Cofinity Commercial |
$1,314.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.05
|
| Rate for Payer: Healthscope Commercial |
$1,375.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.61
|
| Rate for Payer: PHP Commercial |
$1,299.49
|
| Rate for Payer: Priority Health SBD |
$963.15
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$140.79
|
|
|
Service Code
|
NDC 43547000503
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Aetna Medicare |
$70.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.51
|
| Rate for Payer: BCBS Complete |
$56.32
|
| Rate for Payer: Cash Price |
$112.63
|
| Rate for Payer: Cofinity Advantage |
$98.55
|
| Rate for Payer: Cofinity Commercial |
$121.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.63
|
| Rate for Payer: Healthscope Commercial |
$126.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.59
|
| Rate for Payer: PHP Commercial |
$119.67
|
| Rate for Payer: Priority Health SBD |
$88.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.51
|
| Rate for Payer: UHC Core |
$73.35
|
| Rate for Payer: UHC Exchange |
$55.33
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$11.46
|
|
|
Service Code
|
NDC 60687078611
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Advantage |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.60
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.45
|
| Rate for Payer: UHC Core |
$5.97
|
| Rate for Payer: UHC Exchange |
$4.50
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$5,960.78
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,755.29 |
| Max. Negotiated Rate |
$5,364.70 |
| Rate for Payer: Aetna Commercial |
$5,066.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,874.51
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cofinity Advantage |
$4,172.55
|
| Rate for Payer: Cofinity Commercial |
$5,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,768.62
|
| Rate for Payer: Healthscope Commercial |
$5,364.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,066.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,470.59
|
| Rate for Payer: PHP Commercial |
$5,066.66
|
| Rate for Payer: Priority Health SBD |
$3,755.29
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$5,960.78
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$5,364.70 |
| Rate for Payer: Aetna Commercial |
$5,066.66
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,874.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.70
|
| Rate for Payer: BCN Commercial |
$27.70
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cofinity Advantage |
$4,172.55
|
| Rate for Payer: Cofinity Commercial |
$5,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,768.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$5,364.70
|
| Rate for Payer: Mclaren Medicaid |
$5.81
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,066.66
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,470.59
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$5,066.66
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$3,755.29
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: VA VA |
$11.11
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$11,921.56
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,510.58 |
| Max. Negotiated Rate |
$10,729.40 |
| Rate for Payer: Aetna Commercial |
$10,133.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,749.01
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cofinity Advantage |
$8,345.09
|
| Rate for Payer: Cofinity Commercial |
$10,252.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,537.25
|
| Rate for Payer: Healthscope Commercial |
$10,729.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,133.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,941.17
|
| Rate for Payer: PHP Commercial |
$10,133.33
|
| Rate for Payer: Priority Health SBD |
$7,510.58
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$11,921.56
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$10,729.40 |
| Rate for Payer: Aetna Commercial |
$10,133.33
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,749.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.70
|
| Rate for Payer: BCN Commercial |
$27.70
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cofinity Advantage |
$8,345.09
|
| Rate for Payer: Cofinity Commercial |
$10,252.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,537.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$10,729.40
|
| Rate for Payer: Mclaren Medicaid |
$5.81
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,133.33
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,941.17
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$10,133.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$7,510.58
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: VA VA |
$11.11
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$23,843.12
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,021.17 |
| Max. Negotiated Rate |
$21,458.81 |
| Rate for Payer: Aetna Commercial |
$20,266.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,498.03
|
| Rate for Payer: Cash Price |
$19,074.50
|
| Rate for Payer: Cofinity Advantage |
$16,690.18
|
| Rate for Payer: Cofinity Commercial |
$20,505.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,074.50
|
| Rate for Payer: Healthscope Commercial |
$21,458.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,266.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,882.34
|
| Rate for Payer: PHP Commercial |
$20,266.65
|
| Rate for Payer: Priority Health SBD |
$15,021.17
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$23,843.12
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$21,458.81 |
| Rate for Payer: Aetna Commercial |
$20,266.65
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,498.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$27.70
|
| Rate for Payer: BCN Commercial |
$27.70
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$19,074.50
|
| Rate for Payer: Cash Price |
$19,074.50
|
| Rate for Payer: Cofinity Advantage |
$16,690.18
|
| Rate for Payer: Cofinity Commercial |
$20,505.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,074.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$21,458.81
|
| Rate for Payer: Mclaren Medicaid |
$5.81
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,266.65
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,882.34
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$20,266.65
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$15,021.17
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: VA VA |
$11.11
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,416.15
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$3,974.53 |
| Rate for Payer: Aetna Commercial |
$3,753.73
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,870.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.24
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS MAPPO |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$30.36
|
| Rate for Payer: BCBS Trust/PPO |
$30.36
|
| Rate for Payer: BCN Commercial |
$30.36
|
| Rate for Payer: BCN Commercial |
$30.36
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: BCN Medicare Advantage |
$12.19
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cofinity Advantage |
$3,091.30
|
| Rate for Payer: Cofinity Advantage |
$2,804.19
|
| Rate for Payer: Cofinity Commercial |
$3,797.89
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,532.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.19
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Healthscope Commercial |
$3,974.53
|
| Rate for Payer: Mclaren Medicaid |
$6.38
|
| Rate for Payer: Mclaren Medicaid |
$6.38
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Mclaren Medicare |
$12.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: Meridian Medicaid |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,753.73
|
| Rate for Payer: Nomi Health Commercial |
$36.57
|
| Rate for Payer: Nomi Health Commercial |
$36.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,312.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,004.49
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE Medicare |
$11.58
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PACE SWMI |
$12.19
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Commercial |
$3,753.73
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: PHP Medicare Advantage |
$12.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.06
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health Medicare |
$12.19
|
| Rate for Payer: Priority Health SBD |
$2,782.17
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: Priority Health Tiered Network |
$30.45
|
| Rate for Payer: Priority Health Tiered Network |
$30.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.98
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Core |
$19.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.19
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Exchange |
$19.98
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHC Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$6.38
|
| Rate for Payer: VA VA |
$12.19
|
| Rate for Payer: VA VA |
$12.19
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,416.15
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,782.17 |
| Max. Negotiated Rate |
$3,974.53 |
| Rate for Payer: Aetna Commercial |
$3,753.73
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,870.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,532.92
|
| Rate for Payer: Cofinity Advantage |
$3,091.30
|
| Rate for Payer: Cofinity Advantage |
$2,804.19
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Commercial |
$3,797.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,532.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Healthscope Commercial |
$3,974.53
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,753.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,004.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,312.11
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Commercial |
$3,753.73
|
| Rate for Payer: Priority Health SBD |
$2,782.17
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
|
|
ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$23,199.80
|
|
|
Service Code
|
HCPCS C9399
|
| Hospital Charge Code |
198774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,117.52 |
| Max. Negotiated Rate |
$20,879.82 |
| Rate for Payer: Aetna Commercial |
$19,719.83
|
| Rate for Payer: Aetna Medicare |
$11,599.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,079.87
|
| Rate for Payer: BCBS Complete |
$9,279.92
|
| Rate for Payer: Cash Price |
$18,559.84
|
| Rate for Payer: Cofinity Advantage |
$16,239.86
|
| Rate for Payer: Cofinity Commercial |
$19,951.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18,559.84
|
| Rate for Payer: Healthscope Commercial |
$20,879.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,559.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,719.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17,399.85
|
| Rate for Payer: PHP Commercial |
$19,719.83
|
| Rate for Payer: Priority Health SBD |
$14,615.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,079.87
|
| Rate for Payer: UHC Core |
$12,087.10
|
| Rate for Payer: UHC Exchange |
$9,117.52
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.05 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: Aetna Medicare |
$166.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.74
|
| Rate for Payer: BCBS Complete |
$133.38
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Advantage |
$233.41
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.09
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health SBD |
$210.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.74
|
| Rate for Payer: UHC Core |
$173.73
|
| Rate for Payer: UHC Exchange |
$131.05
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.07 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.74
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Advantage |
$233.41
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.09
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health SBD |
$210.07
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 43547026910
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
IP
|
$263.20
|
|
|
Service Code
|
NDC 68462025401
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.82 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
IP
|
$171.95
|
|
|
Service Code
|
NDC 50268074215
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Aetna Commercial |
$146.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.77
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cofinity Advantage |
$120.36
|
| Rate for Payer: Cofinity Commercial |
$147.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.56
|
| Rate for Payer: Healthscope Commercial |
$154.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.96
|
| Rate for Payer: PHP Commercial |
$146.16
|
| Rate for Payer: Priority Health SBD |
$108.33
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$263.20
|
|
|
Service Code
|
NDC 68462025401
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.44 |
| Max. Negotiated Rate |
$236.88 |
| Rate for Payer: Aetna Commercial |
$223.72
|
| Rate for Payer: Aetna Medicare |
$131.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.08
|
| Rate for Payer: BCBS Complete |
$105.28
|
| Rate for Payer: Cash Price |
$210.56
|
| Rate for Payer: Cofinity Advantage |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$226.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.56
|
| Rate for Payer: Healthscope Commercial |
$236.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.40
|
| Rate for Payer: PHP Commercial |
$223.72
|
| Rate for Payer: Priority Health SBD |
$165.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.08
|
| Rate for Payer: UHC Core |
$137.13
|
| Rate for Payer: UHC Exchange |
$103.44
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$171.95
|
|
|
Service Code
|
NDC 50268074215
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.58 |
| Max. Negotiated Rate |
$154.75 |
| Rate for Payer: Aetna Commercial |
$146.16
|
| Rate for Payer: Aetna Medicare |
$85.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.77
|
| Rate for Payer: BCBS Complete |
$68.78
|
| Rate for Payer: Cash Price |
$137.56
|
| Rate for Payer: Cofinity Advantage |
$120.36
|
| Rate for Payer: Cofinity Commercial |
$147.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.56
|
| Rate for Payer: Healthscope Commercial |
$154.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.96
|
| Rate for Payer: PHP Commercial |
$146.16
|
| Rate for Payer: Priority Health SBD |
$108.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.77
|
| Rate for Payer: UHC Core |
$89.59
|
| Rate for Payer: UHC Exchange |
$67.58
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 50268074211
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.24
|
| Rate for Payer: BCBS Complete |
$1.38
|
| Rate for Payer: Cash Price |
$2.75
|
| Rate for Payer: Cofinity Advantage |
$2.41
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$3.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$1.79
|
| Rate for Payer: UHC Exchange |
$1.35
|
|
