|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
OP
|
$3,974.31
|
|
|
Service Code
|
CPT 49592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,785.06 |
| Max. Negotiated Rate |
$3,974.31 |
| Rate for Payer: BCBS Complete |
$3,974.31
|
| Rate for Payer: Mclaren Medicaid |
$3,785.06
|
| Rate for Payer: Meridian Medicaid |
$3,974.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,785.06
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
OP
|
$2,382.99
|
|
|
Service Code
|
CPT 49591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,269.51 |
| Max. Negotiated Rate |
$2,382.99 |
| Rate for Payer: BCBS Complete |
$2,382.99
|
| Rate for Payer: Mclaren Medicaid |
$2,269.51
|
| Rate for Payer: Meridian Medicaid |
$2,382.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,269.51
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
OP
|
$3,974.31
|
|
|
Service Code
|
CPT 49614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,785.06 |
| Max. Negotiated Rate |
$3,974.31 |
| Rate for Payer: BCBS Complete |
$3,974.31
|
| Rate for Payer: Mclaren Medicaid |
$3,785.06
|
| Rate for Payer: Meridian Medicaid |
$3,974.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,785.06
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
OP
|
$2,382.99
|
|
|
Service Code
|
CPT 49613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,269.51 |
| Max. Negotiated Rate |
$2,382.99 |
| Rate for Payer: BCBS Complete |
$2,382.99
|
| Rate for Payer: Mclaren Medicaid |
$2,269.51
|
| Rate for Payer: Meridian Medicaid |
$2,382.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,269.51
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
OP
|
$5,211.10
|
|
|
Service Code
|
CPT 49521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,962.95 |
| Max. Negotiated Rate |
$5,211.10 |
| Rate for Payer: BCBS Complete |
$5,211.10
|
| Rate for Payer: Mclaren Medicaid |
$4,962.95
|
| Rate for Payer: Meridian Medicaid |
$5,211.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,962.95
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
OP
|
$2,382.99
|
|
|
Service Code
|
CPT 49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,269.51 |
| Max. Negotiated Rate |
$2,382.99 |
| Rate for Payer: BCBS Complete |
$2,382.99
|
| Rate for Payer: Mclaren Medicaid |
$2,269.51
|
| Rate for Payer: Meridian Medicaid |
$2,382.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,269.51
|
|
|
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
|
Facility
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
OP
|
$170.23
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$170.23 |
| Rate for Payer: BCBS Complete |
$170.23
|
| Rate for Payer: Mclaren Medicaid |
$162.12
|
| Rate for Payer: Meridian Medicaid |
$170.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.12
|
|
|
RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE
|
Facility
OP
|
$2,229.50
|
|
|
Service Code
|
CPT 28126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.34 |
| Max. Negotiated Rate |
$2,229.50 |
| Rate for Payer: BCBS Complete |
$2,229.50
|
| Rate for Payer: Mclaren Medicaid |
$2,123.34
|
| Rate for Payer: Meridian Medicaid |
$2,229.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,123.34
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
IP
|
$260.97
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.17 |
| Max. Negotiated Rate |
$234.87 |
| Rate for Payer: Aetna Commercial |
$221.82
|
| Rate for Payer: BCBS Trust/PPO |
$201.68
|
| Rate for Payer: BCN Commercial |
$201.68
|
| Rate for Payer: Cash Price |
$208.78
|
| Rate for Payer: Cofinity Commercial |
$224.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.78
|
| Rate for Payer: Healthscope Commercial |
$234.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.82
|
| Rate for Payer: PHP Commercial |
$221.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.65
|
| Rate for Payer: UHC Core |
$217.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.73
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
IP
|
$10,872.90
|
|
|
Service Code
|
NDC 65649-303-03
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,631.38 |
| Max. Negotiated Rate |
$9,785.61 |
| Rate for Payer: Aetna Commercial |
$9,241.96
|
| Rate for Payer: BCBS Trust/PPO |
$8,402.58
|
| Rate for Payer: BCN Commercial |
$8,402.58
|
| Rate for Payer: Cash Price |
$8,698.32
|
| Rate for Payer: Cofinity Commercial |
$9,350.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,698.32
|
| Rate for Payer: Healthscope Commercial |
$9,785.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,154.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,241.96
|
| Rate for Payer: PHP Commercial |
$9,241.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,611.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,459.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6,631.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,568.15
|
| Rate for Payer: UHC Core |
$9,078.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,154.68
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
IP
|
$26.79
|
|
|
Service Code
|
NDC 68382-112-14
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Aetna Commercial |
$22.77
|
| Rate for Payer: BCBS Trust/PPO |
$20.70
|
| Rate for Payer: BCN Commercial |
$20.70
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$24.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.77
|
| Rate for Payer: PHP Commercial |
$22.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.58
|
| Rate for Payer: UHC Core |
$22.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.09
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
IP
|
$399.50
|
|
|
Service Code
|
NDC 68084-270-11
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.66 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: BCBS Trust/PPO |
$308.73
|
| Rate for Payer: BCN Commercial |
$308.73
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
IP
|
$310.20
|
|
|
Service Code
|
NDC 0904-6357-61
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.19 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: BCBS Trust/PPO |
$239.72
|
| Rate for Payer: BCN Commercial |
$239.72
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.67
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.98
|
| Rate for Payer: UHC Core |
$259.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
IP
|
$399.50
|
|
|
Service Code
|
NDC 68084-270-01
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.66 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: BCBS Trust/PPO |
$308.73
|
| Rate for Payer: BCN Commercial |
$308.73
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
IP
|
$399.50
|
|
|
Service Code
|
NDC 0904-6358-61
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.66 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: BCBS Trust/PPO |
$308.73
|
| Rate for Payer: BCN Commercial |
$308.73
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$347.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$243.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
IP
|
$419.03
|
|
|
Service Code
|
NDC 50458-596-01
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.57 |
| Max. Negotiated Rate |
$377.13 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: BCBS Trust/PPO |
$323.83
|
| Rate for Payer: BCN Commercial |
$323.83
|
| Rate for Payer: Cash Price |
$335.22
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.22
|
| Rate for Payer: Healthscope Commercial |
$377.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.18
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.75
|
| Rate for Payer: UHC Core |
$349.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.27
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
IP
|
$2.68
|
|
|
Service Code
|
NDC 9900-0003-48
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
IP
|
$565.22
|
|
|
Service Code
|
NDC 50458-305-03
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.73 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$436.80
|
| Rate for Payer: BCN Commercial |
$436.80
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$480.44
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$491.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.39
|
| Rate for Payer: UHC Core |
$471.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
IP
|
$5.36
|
|
|
Service Code
|
NDC 9900-0003-49
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$4.14
|
| Rate for Payer: BCN Commercial |
$4.14
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.56
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
IP
|
$92.63
|
|
|
Service Code
|
NDC 65162-673-84
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$83.37 |
| Rate for Payer: Aetna Commercial |
$78.74
|
| Rate for Payer: BCBS Trust/PPO |
$71.58
|
| Rate for Payer: BCN Commercial |
$71.58
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cofinity Commercial |
$79.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$83.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.74
|
| Rate for Payer: PHP Commercial |
$78.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.51
|
| Rate for Payer: UHC Core |
$77.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.47
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
IP
|
$1.34
|
|
|
Service Code
|
NDC 9900-0018-54
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.04
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.14
|
| Rate for Payer: PHP Commercial |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.18
|
| Rate for Payer: UHC Core |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.00
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
IP
|
$338.40
|
|
|
Service Code
|
NDC 0904-6359-61
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$261.52
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE MICROSPHERES ER 12.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS
|
Facility
IP
|
$994.29
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
81838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$894.86 |
| Rate for Payer: Aetna Commercial |
$845.15
|
| Rate for Payer: BCBS Trust/PPO |
$768.39
|
| Rate for Payer: BCN Commercial |
$768.39
|
| Rate for Payer: Cash Price |
$795.43
|
| Rate for Payer: Cofinity Commercial |
$855.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.43
|
| Rate for Payer: Healthscope Commercial |
$894.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$845.15
|
| Rate for Payer: PHP Commercial |
$845.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$865.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$606.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$874.98
|
| Rate for Payer: UHC Core |
$830.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.72
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
IP
|
$1,792.36
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,093.16 |
| Max. Negotiated Rate |
$1,613.12 |
| Rate for Payer: Aetna Commercial |
$1,523.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.14
|
| Rate for Payer: BCN Commercial |
$1,385.14
|
| Rate for Payer: Cash Price |
$1,433.89
|
| Rate for Payer: Cofinity Commercial |
$1,541.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.89
|
| Rate for Payer: Healthscope Commercial |
$1,613.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,523.51
|
| Rate for Payer: PHP Commercial |
$1,523.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,559.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,093.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.28
|
| Rate for Payer: UHC Core |
$1,496.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.27
|
|
