|
QUETIAPINE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$301.92
|
|
|
Service Code
|
NDC 00904680161
|
| Hospital Charge Code |
95676
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.25 |
| Max. Negotiated Rate |
$271.73 |
| Rate for Payer: Aetna Commercial |
$256.63
|
| Rate for Payer: BCBS Trust/PPO |
$246.46
|
| Rate for Payer: BCN Commercial |
$233.32
|
| Rate for Payer: Cash Price |
$241.54
|
| Rate for Payer: Cofinity Commercial |
$259.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.54
|
| Rate for Payer: Healthscope Commercial |
$271.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.63
|
| Rate for Payer: Nomi Health Commercial |
$247.57
|
| Rate for Payer: PHP Commercial |
$256.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.25
|
| Rate for Payer: Priority Health HMO/PPO |
$262.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.69
|
| Rate for Payer: UHC Core |
$252.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.44
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
IP
|
$408.90
|
|
|
Service Code
|
NDC 00185434601
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$265.79 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$333.79
|
| Rate for Payer: BCN Commercial |
$316.00
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.56
|
| Rate for Payer: Nomi Health Commercial |
$335.30
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.79
|
| Rate for Payer: Priority Health HMO/PPO |
$355.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.83
|
| Rate for Payer: UHC Core |
$341.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
QUINIDINE SULFATE 200 MG TABLET
|
Facility
|
OP
|
$408.90
|
|
|
Service Code
|
NDC 00185434601
|
| Hospital Charge Code |
6777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.11 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: Aetna Medicare |
$106.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.78
|
| Rate for Payer: BCBS Complete |
$163.56
|
| Rate for Payer: BCBS MAPPO |
$102.22
|
| Rate for Payer: BCBS Trust/PPO |
$336.16
|
| Rate for Payer: BCN Commercial |
$317.92
|
| Rate for Payer: BCN Medicare Advantage |
$102.22
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.22
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.56
|
| Rate for Payer: Nomi Health Commercial |
$335.30
|
| Rate for Payer: PACE Senior Care Partners |
$97.11
|
| Rate for Payer: PACE SWMI |
$102.22
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: PHP Medicare Advantage |
$102.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.79
|
| Rate for Payer: Priority Health HMO/PPO |
$355.74
|
| Rate for Payer: Priority Health Medicare |
$103.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.96
|
| Rate for Payer: Railroad Medicare Medicare |
$102.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.83
|
| Rate for Payer: UHC Core |
$341.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.22
|
| Rate for Payer: UHC Exchange |
$102.22
|
| Rate for Payer: UHC Medicare Advantage |
$102.22
|
| Rate for Payer: VA VA |
$102.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$2,016.48
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,310.71 |
| Max. Negotiated Rate |
$1,814.83 |
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna Commercial |
$6,963.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,687.11
|
| Rate for Payer: BCN Commercial |
$1,558.34
|
| Rate for Payer: BCN Commercial |
$6,330.76
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cofinity Commercial |
$7,045.10
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,553.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Healthscope Commercial |
$1,814.83
|
| Rate for Payer: Healthscope Commercial |
$7,372.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,143.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,963.18
|
| Rate for Payer: Nomi Health Commercial |
$1,653.51
|
| Rate for Payer: Nomi Health Commercial |
$6,717.42
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: PHP Commercial |
$6,963.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,324.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health HMO/PPO |
$7,127.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,754.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,351.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,488.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,774.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,208.94
|
| Rate for Payer: UHC Core |
$1,683.76
|
| Rate for Payer: UHC Core |
$6,840.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,143.98
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$2,016.48
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.33 |
| Max. Negotiated Rate |
$1,814.83 |
| Rate for Payer: Aetna Commercial |
$1,714.01
|
| Rate for Payer: Aetna Commercial |
$6,963.18
|
| Rate for Payer: Aetna Medicare |
$524.28
|
| Rate for Payer: Aetna Medicare |
$2,129.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$630.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,559.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$630.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,559.99
|
| Rate for Payer: BCBS Complete |
$212.46
|
| Rate for Payer: BCBS Complete |
$212.46
|
| Rate for Payer: BCBS MAPPO |
$2,047.99
|
| Rate for Payer: BCBS MAPPO |
$504.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,657.75
|
| Rate for Payer: BCBS Trust/PPO |
$6,734.63
|
| Rate for Payer: BCN Commercial |
$1,567.81
|
| Rate for Payer: BCN Commercial |
$6,369.26
|
| Rate for Payer: BCN Medicare Advantage |
$504.12
|
| Rate for Payer: BCN Medicare Advantage |
$2,047.99
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$1,613.18
|
| Rate for Payer: Cash Price |
$6,553.58
|
| Rate for Payer: Cofinity Commercial |
$1,734.17
|
| Rate for Payer: Cofinity Commercial |
$7,045.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,553.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$504.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,047.99
|
| Rate for Payer: Healthscope Commercial |
$7,372.78
|
| Rate for Payer: Healthscope Commercial |
$1,814.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,143.98
|
| Rate for Payer: Mclaren Medicaid |
$202.33
|
| Rate for Payer: Mclaren Medicaid |
$202.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,150.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$529.33
|
| Rate for Payer: Meridian Medicaid |
$212.46
|
| Rate for Payer: Meridian Medicaid |
$212.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$579.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,355.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,714.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,963.18
|
| Rate for Payer: Nomi Health Commercial |
$1,653.51
|
| Rate for Payer: Nomi Health Commercial |
$6,717.42
|
| Rate for Payer: PACE Senior Care Partners |
$478.91
|
| Rate for Payer: PACE Senior Care Partners |
$1,945.60
|
| Rate for Payer: PACE SWMI |
$504.12
|
| Rate for Payer: PACE SWMI |
$2,047.99
|
| Rate for Payer: PHP Commercial |
$6,963.18
|
| Rate for Payer: PHP Commercial |
$1,714.01
|
| Rate for Payer: PHP Medicare Advantage |
$504.12
|
| Rate for Payer: PHP Medicare Advantage |
$2,047.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,310.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,324.79
|
| Rate for Payer: Priority Health HMO/PPO |
$7,127.02
|
| Rate for Payer: Priority Health HMO/PPO |
$1,754.34
|
| Rate for Payer: Priority Health Medicare |
$509.16
|
| Rate for Payer: Priority Health Medicare |
$2,068.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,351.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,488.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,047.99
|
| Rate for Payer: Railroad Medicare Medicare |
$504.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,208.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,774.50
|
| Rate for Payer: UHC Core |
$6,840.30
|
| Rate for Payer: UHC Core |
$1,683.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$504.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,047.99
|
| Rate for Payer: UHC Exchange |
$2,047.99
|
| Rate for Payer: UHC Exchange |
$504.12
|
| Rate for Payer: UHC Medicare Advantage |
$2,047.99
|
| Rate for Payer: UHC Medicare Advantage |
$504.12
|
| Rate for Payer: UHCCP Medicaid |
$202.33
|
| Rate for Payer: UHCCP Medicaid |
$202.33
|
| Rate for Payer: VA VA |
$504.12
|
| Rate for Payer: VA VA |
$2,047.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,143.98
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,018.31
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$661.90 |
| Max. Negotiated Rate |
$916.48 |
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: BCBS Trust/PPO |
$831.25
|
| Rate for Payer: BCBS Trust/PPO |
$990.11
|
| Rate for Payer: BCN Commercial |
$786.95
|
| Rate for Payer: BCN Commercial |
$937.35
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Cofinity Commercial |
$875.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Nomi Health Commercial |
$835.01
|
| Rate for Payer: Nomi Health Commercial |
$994.60
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.90
|
| Rate for Payer: Priority Health HMO/PPO |
$1,055.25
|
| Rate for Payer: Priority Health HMO/PPO |
$885.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$682.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$896.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,067.38
|
| Rate for Payer: UHC Core |
$850.29
|
| Rate for Payer: UHC Core |
$1,012.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,018.31
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$226.79 |
| Max. Negotiated Rate |
$916.48 |
| Rate for Payer: Aetna Commercial |
$865.56
|
| Rate for Payer: Aetna Commercial |
$1,030.99
|
| Rate for Payer: Aetna Medicare |
$264.76
|
| Rate for Payer: Aetna Medicare |
$315.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$318.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$318.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.04
|
| Rate for Payer: BCBS Complete |
$238.15
|
| Rate for Payer: BCBS Complete |
$238.15
|
| Rate for Payer: BCBS MAPPO |
$303.23
|
| Rate for Payer: BCBS MAPPO |
$254.58
|
| Rate for Payer: BCBS Trust/PPO |
$837.15
|
| Rate for Payer: BCBS Trust/PPO |
$997.15
|
| Rate for Payer: BCN Commercial |
$791.74
|
| Rate for Payer: BCN Commercial |
$943.05
|
| Rate for Payer: BCN Medicare Advantage |
$254.58
|
| Rate for Payer: BCN Medicare Advantage |
$303.23
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$814.65
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$875.75
|
| Rate for Payer: Cofinity Commercial |
$1,043.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.23
|
| Rate for Payer: Healthscope Commercial |
$1,091.64
|
| Rate for Payer: Healthscope Commercial |
$916.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$763.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$909.70
|
| Rate for Payer: Mclaren Medicaid |
$226.79
|
| Rate for Payer: Mclaren Medicaid |
$226.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$267.31
|
| Rate for Payer: Meridian Medicaid |
$238.15
|
| Rate for Payer: Meridian Medicaid |
$238.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$292.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$348.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Nomi Health Commercial |
$835.01
|
| Rate for Payer: Nomi Health Commercial |
$994.60
|
| Rate for Payer: PACE Senior Care Partners |
$241.85
|
| Rate for Payer: PACE Senior Care Partners |
$288.07
|
| Rate for Payer: PACE SWMI |
$254.58
|
| Rate for Payer: PACE SWMI |
$303.23
|
| Rate for Payer: PHP Commercial |
$1,030.99
|
| Rate for Payer: PHP Commercial |
$865.56
|
| Rate for Payer: PHP Medicare Advantage |
$254.58
|
| Rate for Payer: PHP Medicare Advantage |
$303.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health HMO/PPO |
$1,055.25
|
| Rate for Payer: Priority Health HMO/PPO |
$885.93
|
| Rate for Payer: Priority Health Medicare |
$257.12
|
| Rate for Payer: Priority Health Medicare |
$306.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$682.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.66
|
| Rate for Payer: Railroad Medicare Medicare |
$303.23
|
| Rate for Payer: Railroad Medicare Medicare |
$254.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,067.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$896.11
|
| Rate for Payer: UHC Core |
$1,012.80
|
| Rate for Payer: UHC Core |
$850.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.23
|
| Rate for Payer: UHC Exchange |
$303.23
|
| Rate for Payer: UHC Exchange |
$254.58
|
| Rate for Payer: UHC Medicare Advantage |
$303.23
|
| Rate for Payer: UHC Medicare Advantage |
$254.58
|
| Rate for Payer: UHCCP Medicaid |
$226.79
|
| Rate for Payer: UHCCP Medicaid |
$226.79
|
| Rate for Payer: VA VA |
$254.58
|
| Rate for Payer: VA VA |
$303.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$763.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$909.70
|
|
|
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 |
$2.42 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.87
|
| 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: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| 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
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$6.02 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: BCBS Trust/PPO |
$5.46
|
| Rate for Payer: BCN Commercial |
$5.17
|
| 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: PHP Commercial |
$5.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.35
|
| Rate for Payer: Priority Health HMO/PPO |
$5.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.48
|
| 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
|
OP
|
$6.69
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| 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 |
$2.68
|
| Rate for Payer: BCBS MAPPO |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.50
|
| Rate for Payer: BCN Commercial |
$5.20
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.69
|
| Rate for Payer: Nomi Health Commercial |
$5.49
|
| 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 Cigna Priority Health |
$4.35
|
| Rate for Payer: Priority Health HMO/PPO |
$5.82
|
| Rate for Payer: Priority Health Medicare |
$1.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.48
|
| 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 Dual Complete DSNP |
$1.67
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UHC Medicare Advantage |
$1.67
|
| 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 |
$0.88 |
| 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 |
$1.49
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.89
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| 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 Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| 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 Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,682.25 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: BCBS Trust/PPO |
$5,880.18
|
| Rate for Payer: BCN Commercial |
$5,566.83
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: Nomi Health Commercial |
$5,906.84
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health HMO/PPO |
$6,267.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,826.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,339.04
|
| Rate for Payer: UHC Core |
$6,014.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,710.82 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: Aetna Medicare |
$1,872.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,251.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,251.08
|
| Rate for Payer: BCBS Complete |
$2,881.38
|
| Rate for Payer: BCBS MAPPO |
$1,800.87
|
| Rate for Payer: BCBS Trust/PPO |
$5,921.96
|
| Rate for Payer: BCN Commercial |
$5,600.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,800.87
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,800.87
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,890.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,070.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: Nomi Health Commercial |
$5,906.84
|
| Rate for Payer: PACE Senior Care Partners |
$1,710.82
|
| Rate for Payer: PACE SWMI |
$1,800.87
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: PHP Medicare Advantage |
$1,800.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health HMO/PPO |
$6,267.01
|
| Rate for Payer: Priority Health Medicare |
$1,818.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,826.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1,800.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,339.04
|
| Rate for Payer: UHC Core |
$6,014.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,800.87
|
| Rate for Payer: UHC Exchange |
$1,800.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,800.87
|
| Rate for Payer: VA VA |
$1,800.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.35 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$67.00
|
| Rate for Payer: BCN Commercial |
$63.43
|
| 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: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health HMO/PPO |
$71.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.99
|
| 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
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.95 |
| 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 |
$43.71
|
| Rate for Payer: BCBS MAPPO |
$27.32
|
| Rate for Payer: BCBS Trust/PPO |
$89.84
|
| Rate for Payer: BCN Commercial |
$84.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| 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 Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health HMO/PPO |
$95.07
|
| Rate for Payer: Priority Health Medicare |
$27.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.22
|
| 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 Dual Complete DSNP |
$27.32
|
| Rate for Payer: UHC Exchange |
$27.32
|
| Rate for Payer: UHC Medicare Advantage |
$27.32
|
| 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
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: BCBS Trust/PPO |
$89.21
|
| Rate for Payer: BCN Commercial |
$84.45
|
| 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: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health HMO/PPO |
$95.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.22
|
| 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 |
$19.49 |
| 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 |
$32.83
|
| Rate for Payer: BCBS MAPPO |
$20.52
|
| Rate for Payer: BCBS Trust/PPO |
$67.48
|
| Rate for Payer: BCN Commercial |
$63.82
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: Nomi Health Commercial |
$67.31
|
| 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 Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health HMO/PPO |
$71.41
|
| Rate for Payer: Priority Health Medicare |
$20.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.99
|
| 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 Dual Complete DSNP |
$20.52
|
| Rate for Payer: UHC Exchange |
$20.52
|
| Rate for Payer: UHC Medicare Advantage |
$20.52
|
| Rate for Payer: VA VA |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
OP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$28.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.78
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: BCBS MAPPO |
$27.02
|
| Rate for Payer: BCBS Trust/PPO |
$88.87
|
| Rate for Payer: BCN Commercial |
$84.05
|
| Rate for Payer: BCN Medicare Advantage |
$27.02
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.02
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: PACE Senior Care Partners |
$25.67
|
| Rate for Payer: PACE SWMI |
$27.02
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: PHP Medicare Advantage |
$27.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.27
|
| Rate for Payer: Priority Health HMO/PPO |
$94.05
|
| Rate for Payer: Priority Health Medicare |
$27.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.43
|
| Rate for Payer: Railroad Medicare Medicare |
$27.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.13
|
| Rate for Payer: UHC Core |
$90.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.02
|
| Rate for Payer: UHC Exchange |
$27.02
|
| Rate for Payer: UHC Medicare Advantage |
$27.02
|
| Rate for Payer: VA VA |
$27.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: BCBS Trust/PPO |
$88.24
|
| Rate for Payer: BCN Commercial |
$83.54
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.27
|
| Rate for Payer: Priority Health HMO/PPO |
$94.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.13
|
| Rate for Payer: UHC Core |
$90.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: BCBS Trust/PPO |
$115.10
|
| Rate for Payer: BCN Commercial |
$108.96
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$36.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.06
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$35.25
|
| Rate for Payer: BCBS Trust/PPO |
$115.92
|
| Rate for Payer: BCN Commercial |
$109.63
|
| Rate for Payer: BCN Medicare Advantage |
$35.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.25
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: PACE Senior Care Partners |
$33.49
|
| Rate for Payer: PACE SWMI |
$35.25
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: PHP Medicare Advantage |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO |
$122.67
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.47
|
| Rate for Payer: Railroad Medicare Medicare |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.08
|
| Rate for Payer: UHC Core |
$117.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.25
|
| Rate for Payer: UHC Exchange |
$35.25
|
| Rate for Payer: UHC Medicare Advantage |
$35.25
|
| Rate for Payer: VA VA |
$35.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.49 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna Medicare |
$99.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.07
|
| Rate for Payer: BCBS Complete |
$152.41
|
| Rate for Payer: BCBS MAPPO |
$95.26
|
| Rate for Payer: BCBS Trust/PPO |
$313.24
|
| Rate for Payer: BCN Commercial |
$296.25
|
| Rate for Payer: BCN Medicare Advantage |
$95.26
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.26
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: Nomi Health Commercial |
$312.44
|
| Rate for Payer: PACE Senior Care Partners |
$90.49
|
| Rate for Payer: PACE SWMI |
$95.26
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: PHP Medicare Advantage |
$95.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.67
|
| Rate for Payer: Priority Health HMO/PPO |
$331.50
|
| Rate for Payer: Priority Health Medicare |
$96.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.29
|
| Rate for Payer: Railroad Medicare Medicare |
$95.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.31
|
| Rate for Payer: UHC Core |
$318.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.26
|
| Rate for Payer: UHC Exchange |
$95.26
|
| Rate for Payer: UHC Medicare Advantage |
$95.26
|
| Rate for Payer: VA VA |
$95.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: BCBS Trust/PPO |
$311.03
|
| Rate for Payer: BCN Commercial |
$294.46
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: Nomi Health Commercial |
$312.44
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.67
|
| Rate for Payer: Priority Health HMO/PPO |
$331.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$255.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.31
|
| Rate for Payer: UHC Core |
$318.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.27
|
| Rate for Payer: BCBS Complete |
$61.79
|
| Rate for Payer: BCBS MAPPO |
$38.62
|
| Rate for Payer: BCBS Trust/PPO |
$126.99
|
| Rate for Payer: BCN Commercial |
$120.10
|
| Rate for Payer: BCN Medicare Advantage |
$38.62
|
| 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: Health Alliance Plan Medicare Advantage |
$38.62
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: PACE Senior Care Partners |
$36.69
|
| Rate for Payer: PACE SWMI |
$38.62
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: PHP Medicare Advantage |
$38.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Medicare |
$39.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.49
|
| Rate for Payer: Railroad Medicare Medicare |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.93
|
| Rate for Payer: UHC Core |
$128.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.62
|
| Rate for Payer: UHC Exchange |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$38.62
|
| Rate for Payer: VA VA |
$38.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.41 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: BCBS Trust/PPO |
$126.09
|
| Rate for Payer: BCN Commercial |
$119.37
|
| 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: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health HMO/PPO |
$134.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.49
|
| 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
|
|
