|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$14,314.23
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$12,882.81 |
| Rate for Payer: Aetna Commercial |
$12,167.10
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,304.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.76
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$11.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.01
|
| Rate for Payer: Cash Price |
$11,451.38
|
| Rate for Payer: Cash Price |
$11,451.38
|
| Rate for Payer: Cofinity Commercial |
$12,310.24
|
| Rate for Payer: Cofinity Commercial |
$10,019.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,451.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.01
|
| Rate for Payer: Healthscope Commercial |
$12,882.81
|
| Rate for Payer: Mclaren Medicaid |
$5.90
|
| Rate for Payer: Mclaren Medicare |
$11.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.56
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,167.10
|
| Rate for Payer: PACE Medicare |
$10.46
|
| Rate for Payer: PACE SWMI |
$11.01
|
| Rate for Payer: PHP Commercial |
$12,167.10
|
| Rate for Payer: PHP Medicare Advantage |
$11.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,304.25
|
| Rate for Payer: Priority Health Medicare |
$11.01
|
| Rate for Payer: Priority Health SBD |
$9,017.96
|
| Rate for Payer: Railroad Medicare Medicare |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.01
|
| Rate for Payer: UHC Medicare Advantage |
$11.01
|
| Rate for Payer: UHCCP Medicaid |
$6.20
|
| Rate for Payer: VA VA |
$11.01
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$14,314.23
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,017.96 |
| Max. Negotiated Rate |
$12,882.81 |
| Rate for Payer: Aetna Commercial |
$12,167.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,304.25
|
| Rate for Payer: Cash Price |
$11,451.38
|
| Rate for Payer: Cofinity Commercial |
$10,019.96
|
| Rate for Payer: Cofinity Commercial |
$12,310.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,451.38
|
| Rate for Payer: Healthscope Commercial |
$12,882.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,167.10
|
| Rate for Payer: PHP Commercial |
$12,167.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,304.25
|
| Rate for Payer: Priority Health SBD |
$9,017.96
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,523.77 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$2,804.19
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$12.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.09
|
| Rate for Payer: BCBS Complete |
$6.79
|
| Rate for Payer: BCBS MAPPO |
$12.07
|
| Rate for Payer: BCN Medicare Advantage |
$12.07
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Commercial |
$2,804.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Mclaren Medicaid |
$6.47
|
| Rate for Payer: Mclaren Medicare |
$12.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.67
|
| Rate for Payer: Meridian Medicaid |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: PACE Medicare |
$11.47
|
| Rate for Payer: PACE SWMI |
$12.07
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$12.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health Medicare |
$12.07
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.07
|
| Rate for Payer: UHCCP Medicaid |
$6.80
|
| Rate for Payer: VA VA |
$12.07
|
|
|
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 Commercial |
$233.41
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.41
|
| 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: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.74
|
| Rate for Payer: Priority Health SBD |
$210.07
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.38 |
| 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 Commercial |
$233.41
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.41
|
| 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: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.74
|
| Rate for Payer: Priority Health SBD |
$210.07
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 68462025401
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 43547026910
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$79.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: BCBS Complete |
$63.92
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health SBD |
$100.67
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 43547026910
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health SBD |
$100.67
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 68462025401
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Medicare |
$133.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.13
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.13
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
|
ROPINIROLE 2 MG TABLET
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 50268074415
|
| Hospital Charge Code |
21690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.08 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.15
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
ROPINIROLE 2 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 43547027110
|
| Hospital Charge Code |
21690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
|
ROPINIROLE 2 MG TABLET
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 50268074415
|
| Hospital Charge Code |
21690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.32 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Commercial |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.15
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
ROPINIROLE 2 MG TABLET
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 50268074411
|
| Hospital Charge Code |
21690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.56
|
|
|
ROPINIROLE 2 MG TABLET
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 50268074411
|
| Hospital Charge Code |
21690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$2.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: BCBS Complete |
$1.63
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.65
|
| Rate for Payer: Priority Health SBD |
$2.56
|
|
|
ROPINIROLE 2 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 43547027110
|
| Hospital Charge Code |
21690
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
|
ROPIVACAINE 0.2 % FOR NERVE BLOCK INJECTION
|
Facility
|
IP
|
$96.98
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
161560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$87.28 |
| Rate for Payer: Aetna Commercial |
$82.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.04
|
| Rate for Payer: Cash Price |
$77.58
|
| Rate for Payer: Cofinity Commercial |
$67.89
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.58
|
| Rate for Payer: Healthscope Commercial |
$87.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.43
|
| Rate for Payer: PHP Commercial |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.04
|
| Rate for Payer: Priority Health SBD |
$61.10
|
|
|
ROPIVACAINE 0.2 % FOR NERVE BLOCK INJECTION
|
Facility
|
OP
|
$96.98
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
161560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.79 |
| Max. Negotiated Rate |
$87.28 |
| Rate for Payer: Aetna Commercial |
$82.43
|
| Rate for Payer: Aetna Medicare |
$48.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.04
|
| Rate for Payer: BCBS Complete |
$38.79
|
| Rate for Payer: Cash Price |
$77.58
|
| Rate for Payer: Cofinity Commercial |
$67.89
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.58
|
| Rate for Payer: Healthscope Commercial |
$87.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.43
|
| Rate for Payer: PHP Commercial |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.04
|
| Rate for Payer: Priority Health SBD |
$61.10
|
|
|
ROPIVACAINE(PF) 0.2% (2 MG/ML)-SODIUM CHLOR,ISO-OSM INJECTION SOLUTION
|
Facility
|
IP
|
$758.34
|
|
|
Service Code
|
HCPCS j7999
|
| Hospital Charge Code |
189538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$682.51 |
| Rate for Payer: Aetna Commercial |
$644.59
|
| Rate for Payer: Aetna Commercial |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.92
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$606.67
|
| Rate for Payer: Cofinity Commercial |
$652.17
|
| Rate for Payer: Cofinity Commercial |
$530.84
|
| Rate for Payer: Cofinity Commercial |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.67
|
| Rate for Payer: Healthscope Commercial |
$682.51
|
| Rate for Payer: Healthscope Commercial |
$208.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.59
|
| Rate for Payer: PHP Commercial |
$644.59
|
| Rate for Payer: PHP Commercial |
$197.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.92
|
| Rate for Payer: Priority Health SBD |
$146.16
|
| Rate for Payer: Priority Health SBD |
$477.75
|
|
|
ROPIVACAINE(PF) 0.2% (2 MG/ML)-SODIUM CHLOR,ISO-OSM INJECTION SOLUTION
|
Facility
|
OP
|
$758.34
|
|
|
Service Code
|
HCPCS j7999
|
| Hospital Charge Code |
189538
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.34 |
| Max. Negotiated Rate |
$682.51 |
| Rate for Payer: Aetna Commercial |
$644.59
|
| Rate for Payer: Aetna Commercial |
$197.20
|
| Rate for Payer: Aetna Medicare |
$116.00
|
| Rate for Payer: Aetna Medicare |
$379.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.80
|
| Rate for Payer: BCBS Complete |
$303.34
|
| Rate for Payer: BCBS Complete |
$92.80
|
| Rate for Payer: Cash Price |
$606.67
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cofinity Commercial |
$652.17
|
| Rate for Payer: Cofinity Commercial |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Cofinity Commercial |
$530.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.67
|
| Rate for Payer: Healthscope Commercial |
$682.51
|
| Rate for Payer: Healthscope Commercial |
$208.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.20
|
| Rate for Payer: PHP Commercial |
$644.59
|
| Rate for Payer: PHP Commercial |
$197.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.92
|
| Rate for Payer: Priority Health SBD |
$146.16
|
| Rate for Payer: Priority Health SBD |
$477.75
|
|
|
ROPIVACAINE(PF) 0.2% (2 MG/ML)-SODIUM CHLOR,ISO-OSM SOLUTION WRAPPER
|
Facility
|
OP
|
$758.34
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
301466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.34 |
| Max. Negotiated Rate |
$682.51 |
| Rate for Payer: Aetna Commercial |
$644.59
|
| Rate for Payer: Aetna Commercial |
$394.40
|
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: Aetna Medicare |
$379.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.60
|
| Rate for Payer: BCBS Complete |
$303.34
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$606.67
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Commercial |
$652.17
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$399.04
|
| Rate for Payer: Cofinity Commercial |
$530.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.67
|
| Rate for Payer: Healthscope Commercial |
$682.51
|
| Rate for Payer: Healthscope Commercial |
$417.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.40
|
| Rate for Payer: PHP Commercial |
$644.59
|
| Rate for Payer: PHP Commercial |
$394.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.92
|
| Rate for Payer: Priority Health SBD |
$292.32
|
| Rate for Payer: Priority Health SBD |
$477.75
|
|
|
ROPIVACAINE(PF) 0.2% (2 MG/ML)-SODIUM CHLOR,ISO-OSM SOLUTION WRAPPER
|
Facility
|
IP
|
$758.34
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
301466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$477.75 |
| Max. Negotiated Rate |
$682.51 |
| Rate for Payer: Aetna Commercial |
$644.59
|
| Rate for Payer: Aetna Commercial |
$394.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.60
|
| Rate for Payer: Cash Price |
$606.67
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Commercial |
$652.17
|
| Rate for Payer: Cofinity Commercial |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$399.04
|
| Rate for Payer: Cofinity Commercial |
$530.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$530.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.67
|
| Rate for Payer: Healthscope Commercial |
$682.51
|
| Rate for Payer: Healthscope Commercial |
$417.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.40
|
| Rate for Payer: PHP Commercial |
$394.40
|
| Rate for Payer: PHP Commercial |
$644.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.92
|
| Rate for Payer: Priority Health SBD |
$477.75
|
| Rate for Payer: Priority Health SBD |
$292.32
|
|
|
ROPIVACAINE (PF) 0.2 % IN 0.9 % SODIUM CHLORIDE EPIDURAL SOLUTION
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
116044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$223.65 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna Commercial |
$301.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.75
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$248.50
|
| Rate for Payer: Cofinity Commercial |
$305.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.00
|
| Rate for Payer: Healthscope Commercial |
$319.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.75
|
| Rate for Payer: PHP Commercial |
$301.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health SBD |
$223.65
|
|
|
ROPIVACAINE (PF) 0.2 % IN 0.9 % SODIUM CHLORIDE EPIDURAL SOLUTION
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
116044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna Commercial |
$301.75
|
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.75
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$248.50
|
| Rate for Payer: Cofinity Commercial |
$305.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.00
|
| Rate for Payer: Healthscope Commercial |
$319.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.75
|
| Rate for Payer: PHP Commercial |
$301.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health SBD |
$223.65
|
|
|
ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$144.01
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$129.61 |
| Rate for Payer: Aetna Commercial |
$122.41
|
| Rate for Payer: Aetna Commercial |
$34.17
|
| Rate for Payer: Aetna Commercial |
$62.36
|
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Commercial |
$63.84
|
| Rate for Payer: Aetna Commercial |
$68.88
|
| Rate for Payer: Aetna Medicare |
$37.00
|
| Rate for Payer: Aetna Medicare |
$36.69
|
| Rate for Payer: Aetna Medicare |
$47.85
|
| Rate for Payer: Aetna Medicare |
$37.55
|
| Rate for Payer: Aetna Medicare |
$20.10
|
| Rate for Payer: Aetna Medicare |
$72.00
|
| Rate for Payer: Aetna Medicare |
$40.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.61
|
| Rate for Payer: BCBS Complete |
$32.41
|
| Rate for Payer: BCBS Complete |
$16.08
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS Complete |
$29.35
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS Complete |
$30.04
|
| Rate for Payer: BCBS Complete |
$38.28
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cash Price |
$115.21
|
| Rate for Payer: Cash Price |
$58.70
|
| Rate for Payer: Cash Price |
$60.08
|
| Rate for Payer: Cash Price |
$32.16
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cofinity Commercial |
$51.36
|
| Rate for Payer: Cofinity Commercial |
$63.10
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$123.85
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Cofinity Commercial |
$66.99
|
| Rate for Payer: Cofinity Commercial |
$69.69
|
| Rate for Payer: Cofinity Commercial |
$56.72
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$100.81
|
| Rate for Payer: Cofinity Commercial |
$52.57
|
| Rate for Payer: Cofinity Commercial |
$64.59
|
| Rate for Payer: Cofinity Commercial |
$34.57
|
| Rate for Payer: Cofinity Commercial |
$28.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$28.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.21
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Healthscope Commercial |
$129.61
|
| Rate for Payer: Healthscope Commercial |
$36.18
|
| Rate for Payer: Healthscope Commercial |
$67.59
|
| Rate for Payer: Healthscope Commercial |
$72.93
|
| Rate for Payer: Healthscope Commercial |
$66.03
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.90
|
| Rate for Payer: PHP Commercial |
$122.41
|
| Rate for Payer: PHP Commercial |
$63.84
|
| Rate for Payer: PHP Commercial |
$62.36
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Commercial |
$34.17
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.81
|
| Rate for Payer: Priority Health SBD |
$51.05
|
| Rate for Payer: Priority Health SBD |
$46.22
|
| Rate for Payer: Priority Health SBD |
$60.29
|
| Rate for Payer: Priority Health SBD |
$46.62
|
| Rate for Payer: Priority Health SBD |
$25.33
|
| Rate for Payer: Priority Health SBD |
$90.73
|
| Rate for Payer: Priority Health SBD |
$47.31
|
|
