|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$247.77
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Nomi Health Commercial |
$246.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.00
|
| Rate for Payer: UHC Core |
$250.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$14,254.78
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,513.12 |
| Max. Negotiated Rate |
$12,829.30 |
| Rate for Payer: Aetna Commercial |
$12,116.56
|
| Rate for Payer: Aetna Commercial |
$2,731.73
|
| Rate for Payer: Aetna Commercial |
$2,423.32
|
| Rate for Payer: Aetna Medicare |
$835.59
|
| Rate for Payer: Aetna Medicare |
$3,706.24
|
| Rate for Payer: Aetna Medicare |
$741.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,004.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$890.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,454.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$890.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,454.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,004.31
|
| Rate for Payer: BCBS Complete |
$527.71
|
| Rate for Payer: BCBS Complete |
$2,638.56
|
| Rate for Payer: BCBS Complete |
$594.87
|
| Rate for Payer: BCBS MAPPO |
$803.45
|
| Rate for Payer: BCBS MAPPO |
$3,563.70
|
| Rate for Payer: BCBS MAPPO |
$712.74
|
| Rate for Payer: BCBS Trust/PPO |
$11,718.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,343.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,642.06
|
| Rate for Payer: BCN Commercial |
$2,343.77
|
| Rate for Payer: BCN Commercial |
$2,642.06
|
| Rate for Payer: BCN Commercial |
$11,718.85
|
| Rate for Payer: BCN Medicare Advantage |
$803.45
|
| Rate for Payer: BCN Medicare Advantage |
$712.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,563.70
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cofinity Commercial |
$12,259.11
|
| Rate for Payer: Cofinity Commercial |
$2,451.83
|
| Rate for Payer: Cofinity Commercial |
$2,763.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,403.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,280.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,571.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$803.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,563.70
|
| Rate for Payer: Healthscope Commercial |
$2,565.86
|
| Rate for Payer: Healthscope Commercial |
$12,829.30
|
| Rate for Payer: Healthscope Commercial |
$2,892.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,410.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,691.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,138.22
|
| Rate for Payer: Mclaren Medicaid |
$2,513.12
|
| Rate for Payer: Mclaren Medicaid |
$566.59
|
| Rate for Payer: Mclaren Medicaid |
$502.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,741.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$748.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$843.62
|
| Rate for Payer: Meridian Medicaid |
$594.87
|
| Rate for Payer: Meridian Medicaid |
$2,638.56
|
| Rate for Payer: Meridian Medicaid |
$527.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$819.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,098.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$923.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$883.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$784.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,920.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,731.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,423.32
|
| Rate for Payer: Nomi Health Commercial |
$2,635.32
|
| Rate for Payer: Nomi Health Commercial |
$2,337.79
|
| Rate for Payer: Nomi Health Commercial |
$11,688.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,410.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,691.08
|
| Rate for Payer: PACE Senior Care Partners |
$677.10
|
| Rate for Payer: PACE Senior Care Partners |
$3,385.51
|
| Rate for Payer: PACE Senior Care Partners |
$763.28
|
| Rate for Payer: PACE SWMI |
$803.45
|
| Rate for Payer: PACE SWMI |
$712.74
|
| Rate for Payer: PACE SWMI |
$3,563.70
|
| Rate for Payer: PHP Commercial |
$12,116.56
|
| Rate for Payer: PHP Commercial |
$2,731.73
|
| Rate for Payer: PHP Commercial |
$2,423.32
|
| Rate for Payer: PHP Medicare Advantage |
$712.74
|
| Rate for Payer: PHP Medicare Advantage |
$3,563.70
|
| Rate for Payer: PHP Medicare Advantage |
$803.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,513.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$502.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$566.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,480.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,401.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,796.01
|
| Rate for Payer: Priority Health Medicare |
$811.48
|
| Rate for Payer: Priority Health Medicare |
$719.87
|
| Rate for Payer: Priority Health Medicare |
$3,599.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,984.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,236.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,921.33
|
| Rate for Payer: Railroad Medicare Medicare |
$712.74
|
| Rate for Payer: Railroad Medicare Medicare |
$803.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,563.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,508.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,828.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,544.21
|
| Rate for Payer: UHC Core |
$11,902.74
|
| Rate for Payer: UHC Core |
$2,683.52
|
| Rate for Payer: UHC Core |
$2,380.55
|
| Rate for Payer: UHC Exchange |
$803.45
|
| Rate for Payer: UHC Exchange |
$712.74
|
| Rate for Payer: UHC Exchange |
$3,563.70
|
| Rate for Payer: UHC Medicaid |
$2,513.12
|
| Rate for Payer: UHC Medicaid |
$566.59
|
| Rate for Payer: UHC Medicaid |
$502.62
|
| Rate for Payer: UHC Medicare Advantage |
$712.74
|
| Rate for Payer: UHC Medicare Advantage |
$3,563.70
|
| Rate for Payer: UHC Medicare Advantage |
$803.45
|
| Rate for Payer: UHCCP Medicaid |
$502.62
|
| Rate for Payer: UHCCP Medicaid |
$2,513.12
|
| Rate for Payer: UHCCP Medicaid |
$566.59
|
| Rate for Payer: VA VA |
$3,563.70
|
| Rate for Payer: VA VA |
$803.45
|
| Rate for Payer: VA VA |
$712.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,138.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,691.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,410.35
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$14,254.78
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,921.33 |
| Max. Negotiated Rate |
$12,829.30 |
| Rate for Payer: Aetna Commercial |
$12,116.56
|
| Rate for Payer: Aetna Commercial |
$2,423.32
|
| Rate for Payer: Aetna Commercial |
$2,731.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,354.61
|
| Rate for Payer: BCBS Trust/PPO |
$11,773.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,654.28
|
| Rate for Payer: BCN Commercial |
$2,354.61
|
| Rate for Payer: BCN Commercial |
$11,773.02
|
| Rate for Payer: BCN Commercial |
$2,654.28
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cofinity Commercial |
$2,763.87
|
| Rate for Payer: Cofinity Commercial |
$2,451.83
|
| Rate for Payer: Cofinity Commercial |
$12,259.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,280.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,403.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,571.04
|
| Rate for Payer: Healthscope Commercial |
$2,565.86
|
| Rate for Payer: Healthscope Commercial |
$12,829.30
|
| Rate for Payer: Healthscope Commercial |
$2,892.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,410.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,691.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,138.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,423.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,731.73
|
| Rate for Payer: Nomi Health Commercial |
$11,688.92
|
| Rate for Payer: Nomi Health Commercial |
$2,337.79
|
| Rate for Payer: Nomi Health Commercial |
$2,635.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,691.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,410.35
|
| Rate for Payer: PHP Commercial |
$12,116.56
|
| Rate for Payer: PHP Commercial |
$2,731.73
|
| Rate for Payer: PHP Commercial |
$2,423.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,796.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,480.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12,401.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,984.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,236.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9,921.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,828.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,508.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,544.21
|
| Rate for Payer: UHC Core |
$11,902.74
|
| Rate for Payer: UHC Core |
$2,683.52
|
| Rate for Payer: UHC Core |
$2,380.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,410.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,691.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,138.22
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,890.12
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$333.23 |
| Max. Negotiated Rate |
$1,701.11 |
| Rate for Payer: Aetna Commercial |
$1,606.60
|
| Rate for Payer: Aetna Medicare |
$491.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$590.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$590.66
|
| Rate for Payer: BCBS Complete |
$349.86
|
| Rate for Payer: BCBS MAPPO |
$472.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.87
|
| Rate for Payer: BCN Commercial |
$1,553.87
|
| Rate for Payer: BCN Medicare Advantage |
$472.53
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cofinity Commercial |
$1,625.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$472.53
|
| Rate for Payer: Healthscope Commercial |
$1,701.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,417.59
|
| Rate for Payer: Mclaren Medicaid |
$333.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$496.16
|
| Rate for Payer: Meridian Medicaid |
$349.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$543.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$519.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,606.60
|
| Rate for Payer: Nomi Health Commercial |
$1,549.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,417.59
|
| Rate for Payer: PACE Senior Care Partners |
$448.90
|
| Rate for Payer: PACE SWMI |
$472.53
|
| Rate for Payer: PHP Commercial |
$1,606.60
|
| Rate for Payer: PHP Medicare Advantage |
$472.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,644.40
|
| Rate for Payer: Priority Health Medicare |
$477.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.52
|
| Rate for Payer: Railroad Medicare Medicare |
$472.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,663.31
|
| Rate for Payer: UHC Core |
$1,578.25
|
| Rate for Payer: UHC Exchange |
$472.53
|
| Rate for Payer: UHC Medicaid |
$333.23
|
| Rate for Payer: UHC Medicare Advantage |
$472.53
|
| Rate for Payer: UHCCP Medicaid |
$333.23
|
| Rate for Payer: VA VA |
$472.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,417.59
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,890.12
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,315.52 |
| Max. Negotiated Rate |
$1,701.11 |
| Rate for Payer: Aetna Commercial |
$1,606.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,561.05
|
| Rate for Payer: BCN Commercial |
$1,561.05
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cofinity Commercial |
$1,625.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.10
|
| Rate for Payer: Healthscope Commercial |
$1,701.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,417.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,606.60
|
| Rate for Payer: Nomi Health Commercial |
$1,549.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,417.59
|
| Rate for Payer: PHP Commercial |
$1,606.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,644.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,315.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,663.31
|
| Rate for Payer: UHC Core |
$1,578.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,417.59
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.53
|
| Rate for Payer: BCN Commercial |
$5.53
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: Nomi Health Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.89
|
| Rate for Payer: UHC Core |
$5.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.79
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Aetna Medicare |
$1.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.09
|
| Rate for Payer: BCBS Complete |
$1.24
|
| Rate for Payer: BCBS MAPPO |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.50
|
| Rate for Payer: BCN Commercial |
$5.50
|
| Rate for Payer: BCN Medicare Advantage |
$1.67
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$6.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Mclaren Medicaid |
$1.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: Meridian Medicaid |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: Nomi Health Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.02
|
| Rate for Payer: PACE Senior Care Partners |
$1.59
|
| Rate for Payer: PACE SWMI |
$1.67
|
| Rate for Payer: PHP Commercial |
$5.69
|
| Rate for Payer: PHP Medicare Advantage |
$1.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.82
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.89
|
| Rate for Payer: UHC Core |
$5.59
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UHC Medicaid |
$1.18
|
| Rate for Payer: UHC Medicare Advantage |
$1.67
|
| Rate for Payer: UHCCP Medicaid |
$1.18
|
| Rate for Payer: VA VA |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$0.69
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$3.06
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Mclaren Medicaid |
$0.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: Meridian Medicaid |
$0.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.79
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.59
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicaid |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: UHCCP Medicaid |
$0.66
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$10,650.89
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$10,143.70 |
| Max. Negotiated Rate |
$10,650.89 |
| Rate for Payer: BCBS Complete |
$10,650.89
|
| Rate for Payer: Mclaren Medicaid |
$10,143.70
|
| Rate for Payer: Meridian Medicaid |
$10,650.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,143.70
|
| Rate for Payer: UHC Medicaid |
$10,143.70
|
| Rate for Payer: UHCCP Medicaid |
$10,143.70
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$14,109.86
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$13,437.97 |
| Max. Negotiated Rate |
$14,109.86 |
| Rate for Payer: BCBS Complete |
$14,109.86
|
| Rate for Payer: Mclaren Medicaid |
$13,437.97
|
| Rate for Payer: Meridian Medicaid |
$14,109.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,437.97
|
| Rate for Payer: UHC Medicaid |
$13,437.97
|
| Rate for Payer: UHCCP Medicaid |
$13,437.97
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$18,617.89
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$17,731.32 |
| Max. Negotiated Rate |
$18,617.89 |
| Rate for Payer: BCBS Complete |
$18,617.89
|
| Rate for Payer: Mclaren Medicaid |
$17,731.32
|
| Rate for Payer: Meridian Medicaid |
$18,617.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,731.32
|
| Rate for Payer: UHC Medicaid |
$17,731.32
|
| Rate for Payer: UHCCP Medicaid |
$17,731.32
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$4,241.43
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$4,039.45 |
| Max. Negotiated Rate |
$4,241.43 |
| Rate for Payer: BCBS Complete |
$4,241.43
|
| Rate for Payer: Mclaren Medicaid |
$4,039.45
|
| Rate for Payer: Meridian Medicaid |
$4,241.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,039.45
|
| Rate for Payer: UHC Medicaid |
$4,039.45
|
| Rate for Payer: UHCCP Medicaid |
$4,039.45
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,688.31
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,351.06 |
| Max. Negotiated Rate |
$6,919.48 |
| Rate for Payer: Aetna Commercial |
$6,535.06
|
| Rate for Payer: BCBS Trust/PPO |
$6,349.78
|
| Rate for Payer: BCN Commercial |
$6,349.78
|
| Rate for Payer: Cash Price |
$6,150.65
|
| Rate for Payer: Cofinity Commercial |
$6,611.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.65
|
| Rate for Payer: Healthscope Commercial |
$6,919.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,766.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Nomi Health Commercial |
$6,304.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: PHP Commercial |
$6,535.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,688.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,351.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,765.71
|
| Rate for Payer: UHC Core |
$6,419.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,766.23
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,688.31
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,355.45 |
| Max. Negotiated Rate |
$6,919.48 |
| Rate for Payer: Aetna Commercial |
$6,535.06
|
| Rate for Payer: Aetna Medicare |
$1,998.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,402.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,402.60
|
| Rate for Payer: BCBS Complete |
$1,423.11
|
| Rate for Payer: BCBS MAPPO |
$1,922.08
|
| Rate for Payer: BCBS Trust/PPO |
$6,320.56
|
| Rate for Payer: BCN Commercial |
$6,320.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,922.08
|
| Rate for Payer: Cash Price |
$6,150.65
|
| Rate for Payer: Cofinity Commercial |
$6,611.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,922.08
|
| Rate for Payer: Healthscope Commercial |
$6,919.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,766.23
|
| Rate for Payer: Mclaren Medicaid |
$1,355.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,018.18
|
| Rate for Payer: Meridian Medicaid |
$1,423.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,210.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,114.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Nomi Health Commercial |
$6,304.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: PACE Senior Care Partners |
$1,825.97
|
| Rate for Payer: PACE SWMI |
$1,922.08
|
| Rate for Payer: PHP Commercial |
$6,535.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,922.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,355.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6,688.83
|
| Rate for Payer: Priority Health Medicare |
$1,941.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,351.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,922.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,765.71
|
| Rate for Payer: UHC Core |
$6,419.74
|
| Rate for Payer: UHC Exchange |
$1,922.08
|
| Rate for Payer: UHC Medicaid |
$1,355.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,922.08
|
| Rate for Payer: UHCCP Medicaid |
$1,355.45
|
| Rate for Payer: VA VA |
$1,922.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,766.23
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$28.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.15
|
| Rate for Payer: BCBS Complete |
$20.23
|
| Rate for Payer: BCBS MAPPO |
$27.32
|
| Rate for Payer: BCBS Trust/PPO |
$89.84
|
| Rate for Payer: BCN Commercial |
$89.84
|
| Rate for Payer: BCN Medicare Advantage |
$27.32
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.32
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Mclaren Medicaid |
$19.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.69
|
| Rate for Payer: Meridian Medicaid |
$20.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: PACE Senior Care Partners |
$25.95
|
| Rate for Payer: PACE SWMI |
$27.32
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: PHP Medicare Advantage |
$27.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.07
|
| Rate for Payer: Priority Health Medicare |
$27.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.06
|
| Rate for Payer: Railroad Medicare Medicare |
$27.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.17
|
| Rate for Payer: UHC Core |
$91.25
|
| Rate for Payer: UHC Exchange |
$27.32
|
| Rate for Payer: UHC Medicaid |
$19.27
|
| Rate for Payer: UHC Medicare Advantage |
$27.32
|
| Rate for Payer: UHCCP Medicaid |
$19.27
|
| Rate for Payer: VA VA |
$27.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.13 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$67.79
|
| Rate for Payer: BCN Commercial |
$67.79
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: Nomi Health Commercial |
$67.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.56
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.23
|
| Rate for Payer: UHC Core |
$68.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.06 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: BCBS Trust/PPO |
$90.25
|
| Rate for Payer: BCN Commercial |
$90.25
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.17
|
| Rate for Payer: UHC Core |
$91.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.65
|
| Rate for Payer: BCBS Complete |
$15.19
|
| Rate for Payer: BCBS MAPPO |
$20.52
|
| Rate for Payer: BCBS Trust/PPO |
$67.48
|
| Rate for Payer: BCN Commercial |
$67.48
|
| Rate for Payer: BCN Medicare Advantage |
$20.52
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.52
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Mclaren Medicaid |
$14.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.55
|
| Rate for Payer: Meridian Medicaid |
$15.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: Nomi Health Commercial |
$67.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.56
|
| Rate for Payer: PACE Senior Care Partners |
$19.49
|
| Rate for Payer: PACE SWMI |
$20.52
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: PHP Medicare Advantage |
$20.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$71.41
|
| Rate for Payer: Priority Health Medicare |
$20.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.13
|
| Rate for Payer: Railroad Medicare Medicare |
$20.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.23
|
| Rate for Payer: UHC Core |
$68.54
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicaid |
$14.47
|
| Rate for Payer: UHC Medicare Advantage |
$20.52
|
| Rate for Payer: UHCCP Medicaid |
$14.47
|
| Rate for Payer: VA VA |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.87 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: BCBS Trust/PPO |
$91.22
|
| Rate for Payer: BCN Commercial |
$91.22
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$28.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$27.61
|
| Rate for Payer: BCBS Trust/PPO |
$90.80
|
| Rate for Payer: BCN Commercial |
$90.80
|
| Rate for Payer: BCN Medicare Advantage |
$27.61
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.61
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: Mclaren Medicaid |
$19.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.99
|
| Rate for Payer: Meridian Medicaid |
$20.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PACE Senior Care Partners |
$26.23
|
| Rate for Payer: PACE SWMI |
$27.61
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: PHP Medicare Advantage |
$27.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$96.09
|
| Rate for Payer: Priority Health Medicare |
$27.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.87
|
| Rate for Payer: Railroad Medicare Medicare |
$27.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.20
|
| Rate for Payer: UHC Core |
$92.23
|
| Rate for Payer: UHC Exchange |
$27.61
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHC Medicare Advantage |
$27.61
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$27.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.77 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: BCBS Trust/PPO |
$118.39
|
| Rate for Payer: BCN Commercial |
$118.39
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.15
|
| Rate for Payer: UHC Core |
$119.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna Commercial |
$121.85
|
| Rate for Payer: Aetna Medicare |
$37.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.80
|
| Rate for Payer: BCBS Complete |
$26.53
|
| Rate for Payer: BCBS MAPPO |
$35.84
|
| Rate for Payer: BCBS Trust/PPO |
$117.85
|
| Rate for Payer: BCN Commercial |
$117.85
|
| Rate for Payer: BCN Medicare Advantage |
$35.84
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$123.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.84
|
| Rate for Payer: Healthscope Commercial |
$129.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.51
|
| Rate for Payer: Mclaren Medicaid |
$25.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.63
|
| Rate for Payer: Meridian Medicaid |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: PACE Senior Care Partners |
$34.05
|
| Rate for Payer: PACE SWMI |
$35.84
|
| Rate for Payer: PHP Commercial |
$121.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.71
|
| Rate for Payer: Priority Health Medicare |
$36.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.77
|
| Rate for Payer: Railroad Medicare Medicare |
$35.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.15
|
| Rate for Payer: UHC Core |
$119.70
|
| Rate for Payer: UHC Exchange |
$35.84
|
| Rate for Payer: UHC Medicaid |
$25.27
|
| Rate for Payer: UHC Medicare Advantage |
$35.84
|
| Rate for Payer: UHCCP Medicaid |
$25.27
|
| Rate for Payer: VA VA |
$35.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.51
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$984.71 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,168.49
|
| Rate for Payer: BCN Commercial |
$1,168.49
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: Nomi Health Commercial |
$1,160.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,061.11
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,230.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$984.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.03
|
| Rate for Payer: UHC Core |
$1,181.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: BCBS Trust/PPO |
$127.58
|
| Rate for Payer: BCN Commercial |
$127.58
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.85
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
