|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$186.77
|
|
|
Service Code
|
NDC 43547000503
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.67 |
| Max. Negotiated Rate |
$168.09 |
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.40
|
| Rate for Payer: Cash Price |
$149.42
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.42
|
| Rate for Payer: Healthscope Commercial |
$168.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.40
|
| Rate for Payer: Priority Health SBD |
$117.67
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna Medicare |
$742.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.72
|
| Rate for Payer: BCBS Complete |
$593.68
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,038.93
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health SBD |
$935.04
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$116.21
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.21 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.54
|
| Rate for Payer: Cash Price |
$92.97
|
| Rate for Payer: Cofinity Commercial |
$81.35
|
| Rate for Payer: Cofinity Commercial |
$99.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.97
|
| Rate for Payer: Healthscope Commercial |
$104.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.78
|
| Rate for Payer: PHP Commercial |
$98.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.54
|
| Rate for Payer: Priority Health SBD |
$73.21
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$935.04 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.72
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Cofinity Commercial |
$1,038.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health SBD |
$935.04
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$186.77
|
|
|
Service Code
|
NDC 43547000503
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.71 |
| Max. Negotiated Rate |
$168.09 |
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Medicare |
$93.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.40
|
| Rate for Payer: BCBS Complete |
$74.71
|
| Rate for Payer: Cash Price |
$149.42
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.42
|
| Rate for Payer: Healthscope Commercial |
$168.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.40
|
| Rate for Payer: Priority Health SBD |
$117.67
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$116.21
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: Aetna Medicare |
$58.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.54
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: Cash Price |
$92.97
|
| Rate for Payer: Cofinity Commercial |
$81.35
|
| Rate for Payer: Cofinity Commercial |
$99.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.97
|
| Rate for Payer: Healthscope Commercial |
$104.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.78
|
| Rate for Payer: PHP Commercial |
$98.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.54
|
| Rate for Payer: Priority Health SBD |
$73.21
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$29.78
|
| Rate for Payer: BCN Commercial |
$29.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Commercial |
$3,083.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$3,964.00
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: Nomi Health Commercial |
$31.62
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$10.54
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,774.80 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,083.12
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Healthscope Commercial |
$3,964.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,157.13
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$6,441.42 |
| Rate for Payer: Aetna Commercial |
$6,083.56
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,652.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$29.78
|
| Rate for Payer: BCN Commercial |
$29.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cofinity Commercial |
$5,009.99
|
| Rate for Payer: Cofinity Commercial |
$6,155.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,009.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,725.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$6,441.42
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,083.56
|
| Rate for Payer: Nomi Health Commercial |
$31.62
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$6,083.56
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,652.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Priority Health SBD |
$4,508.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$10.54
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,157.13
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,508.99 |
| Max. Negotiated Rate |
$6,441.42 |
| Rate for Payer: Aetna Commercial |
$6,083.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,652.13
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cofinity Commercial |
$5,009.99
|
| Rate for Payer: Cofinity Commercial |
$6,155.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,009.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,725.70
|
| Rate for Payer: Healthscope Commercial |
$6,441.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,083.56
|
| Rate for Payer: PHP Commercial |
$6,083.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,652.13
|
| Rate for Payer: Priority Health SBD |
$4,508.99
|
|
|
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
|
|
|
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 |
$5.65 |
| Max. Negotiated Rate |
$12,882.81 |
| Rate for Payer: Aetna Commercial |
$12,167.10
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,304.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$29.78
|
| Rate for Payer: BCN Commercial |
$29.78
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| 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 |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$12,882.81
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,167.10
|
| Rate for Payer: Nomi Health Commercial |
$31.62
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$12,167.10
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,304.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Priority Health SBD |
$9,017.96
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.93
|
| Rate for Payer: VA VA |
$10.54
|
|
|
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 |
$6.16 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$32.44
|
| Rate for Payer: BCN Commercial |
$32.44
|
| Rate for Payer: BCN Medicare Advantage |
$11.49
|
| 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 |
$11.49
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$34.47
|
| Rate for Payer: PACE Medicare |
$10.92
|
| Rate for Payer: PACE SWMI |
$11.49
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Narrow Network |
$25.73
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.49
|
| Rate for Payer: UHC Medicare Advantage |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$6.47
|
| Rate for Payer: VA VA |
$11.49
|
|
|
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 |
$300.10 |
| 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 |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.10
|
| 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 |
$300.10 |
| 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 |
$233.42
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.10
|
| 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
|
$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
|
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) |
$174.14
|
| 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 |
$174.14
|
| Rate for Payer: Priority Health SBD |
$168.78
|
|
|
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) |
$174.14
|
| 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 |
$174.14
|
| 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 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 |
$172.80
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| 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 |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
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 |
$172.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.14
|
| 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 |
$172.80
|
| Rate for Payer: PHP Commercial |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.14
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
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 |
$147.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| 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 |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
|
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 |
$147.82
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.04
|
| 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 |
$147.82
|
| Rate for Payer: PHP Commercial |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
|
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
|
|
