|
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$180.91
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.28 |
| Max. Negotiated Rate |
$180.91 |
| Rate for Payer: BCBS Complete |
$180.91
|
| Rate for Payer: Mclaren Medicaid |
$172.28
|
| Rate for Payer: Meridian Medicaid |
$180.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.28
|
| Rate for Payer: UHCCP Medicaid |
$172.28
|
|
|
RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE
|
Facility
|
OP
|
$2,413.50
|
|
|
Service Code
|
CPT 28126
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,298.42 |
| Max. Negotiated Rate |
$2,413.50 |
| Rate for Payer: BCBS Complete |
$2,413.50
|
| Rate for Payer: Mclaren Medicaid |
$2,298.42
|
| Rate for Payer: Meridian Medicaid |
$2,413.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,298.42
|
| Rate for Payer: UHCCP Medicaid |
$2,298.42
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$287.31
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.75 |
| Max. Negotiated Rate |
$258.58 |
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: BCBS Trust/PPO |
$234.53
|
| Rate for Payer: BCN Commercial |
$222.03
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health HMO/PPO |
$249.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.83
|
| Rate for Payer: UHC Core |
$239.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$287.31
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$258.58 |
| Rate for Payer: Aetna Commercial |
$244.21
|
| Rate for Payer: Aetna Medicare |
$74.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.78
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS MAPPO |
$71.83
|
| Rate for Payer: BCBS Trust/PPO |
$236.20
|
| Rate for Payer: BCN Commercial |
$223.38
|
| Rate for Payer: BCN Medicare Advantage |
$71.83
|
| Rate for Payer: Cash Price |
$229.85
|
| Rate for Payer: Cofinity Commercial |
$247.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.83
|
| Rate for Payer: Healthscope Commercial |
$258.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: PACE Senior Care Partners |
$68.24
|
| Rate for Payer: PACE SWMI |
$71.83
|
| Rate for Payer: PHP Commercial |
$244.21
|
| Rate for Payer: PHP Medicare Advantage |
$71.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health HMO/PPO |
$249.96
|
| Rate for Payer: Priority Health Medicare |
$72.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.50
|
| Rate for Payer: Railroad Medicare Medicare |
$71.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.83
|
| Rate for Payer: UHC Core |
$239.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.83
|
| Rate for Payer: UHC Exchange |
$71.83
|
| Rate for Payer: UHC Medicare Advantage |
$71.83
|
| Rate for Payer: VA VA |
$71.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.48
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
OP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030303
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,670.10 |
| Max. Negotiated Rate |
$10,118.28 |
| Rate for Payer: Aetna Commercial |
$9,556.15
|
| Rate for Payer: Aetna Medicare |
$2,923.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,513.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,513.29
|
| Rate for Payer: BCBS Complete |
$4,497.01
|
| Rate for Payer: BCBS MAPPO |
$2,810.63
|
| Rate for Payer: BCBS Trust/PPO |
$9,242.48
|
| Rate for Payer: BCN Commercial |
$8,741.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,810.63
|
| Rate for Payer: Cash Price |
$8,994.02
|
| Rate for Payer: Cofinity Commercial |
$9,668.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,810.63
|
| Rate for Payer: Healthscope Commercial |
$10,118.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,431.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,951.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,232.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,556.15
|
| Rate for Payer: Nomi Health Commercial |
$9,218.87
|
| Rate for Payer: PACE Senior Care Partners |
$2,670.10
|
| Rate for Payer: PACE SWMI |
$2,810.63
|
| Rate for Payer: PHP Commercial |
$9,556.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,810.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,307.64
|
| Rate for Payer: Priority Health HMO/PPO |
$9,781.00
|
| Rate for Payer: Priority Health Medicare |
$2,838.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,532.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2,810.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,893.43
|
| Rate for Payer: UHC Core |
$9,387.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,810.63
|
| Rate for Payer: UHC Exchange |
$2,810.63
|
| Rate for Payer: UHC Medicare Advantage |
$2,810.63
|
| Rate for Payer: VA VA |
$2,810.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,431.90
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
IP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030303
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,307.64 |
| Max. Negotiated Rate |
$10,118.28 |
| Rate for Payer: Aetna Commercial |
$9,556.15
|
| Rate for Payer: BCBS Trust/PPO |
$9,177.28
|
| Rate for Payer: BCN Commercial |
$8,688.23
|
| Rate for Payer: Cash Price |
$8,994.02
|
| Rate for Payer: Cofinity Commercial |
$9,668.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.02
|
| Rate for Payer: Healthscope Commercial |
$10,118.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,431.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,556.15
|
| Rate for Payer: Nomi Health Commercial |
$9,218.87
|
| Rate for Payer: PHP Commercial |
$9,556.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,307.64
|
| Rate for Payer: Priority Health HMO/PPO |
$9,781.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,532.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,893.43
|
| Rate for Payer: UHC Core |
$9,387.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,431.90
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Medicare |
$80.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.94
|
| Rate for Payer: BCBS Complete |
$124.08
|
| Rate for Payer: BCBS MAPPO |
$77.55
|
| Rate for Payer: BCBS Trust/PPO |
$255.02
|
| Rate for Payer: BCN Commercial |
$241.18
|
| Rate for Payer: BCN Medicare Advantage |
$77.55
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.55
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Nomi Health Commercial |
$254.36
|
| Rate for Payer: PACE Senior Care Partners |
$73.67
|
| Rate for Payer: PACE SWMI |
$77.55
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: PHP Medicare Advantage |
$77.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health HMO/PPO |
$269.87
|
| Rate for Payer: Priority Health Medicare |
$78.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.83
|
| Rate for Payer: Railroad Medicare Medicare |
$77.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.98
|
| Rate for Payer: UHC Core |
$259.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.55
|
| Rate for Payer: UHC Exchange |
$77.55
|
| Rate for Payer: UHC Medicare Advantage |
$77.55
|
| Rate for Payer: VA VA |
$77.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.62
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$1.55
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Nomi Health Commercial |
$1.63
|
| Rate for Payer: PACE Senior Care Partners |
$0.47
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health HMO/PPO |
$1.73
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.33
|
| Rate for Payer: Railroad Medicare Medicare |
$0.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.75
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.50
|
| Rate for Payer: UHC Exchange |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.50
|
| Rate for Payer: VA VA |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 68084027001
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.06 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: BCBS Trust/PPO |
$162.08
|
| Rate for Payer: BCN Commercial |
$153.44
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Nomi Health Commercial |
$162.81
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health HMO/PPO |
$172.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.72
|
| Rate for Payer: UHC Core |
$165.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.62
|
| Rate for Payer: BCN Commercial |
$1.54
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: Nomi Health Commercial |
$1.63
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health HMO/PPO |
$1.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.75
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$32.36
|
| Rate for Payer: BCBS Trust/PPO |
$31.08
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.36
|
| Rate for Payer: Nomi Health Commercial |
$31.22
|
| Rate for Payer: PHP Commercial |
$32.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health HMO/PPO |
$33.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.50
|
| Rate for Payer: UHC Core |
$31.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.55
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: BCBS Trust/PPO |
$253.22
|
| Rate for Payer: BCN Commercial |
$239.72
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Nomi Health Commercial |
$254.36
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health HMO/PPO |
$269.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.98
|
| Rate for Payer: UHC Core |
$259.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$198.55
|
|
|
Service Code
|
NDC 68084027001
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.16 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.05
|
| Rate for Payer: BCBS Complete |
$79.42
|
| Rate for Payer: BCBS MAPPO |
$49.64
|
| Rate for Payer: BCBS Trust/PPO |
$163.23
|
| Rate for Payer: BCN Commercial |
$154.37
|
| Rate for Payer: BCN Medicare Advantage |
$49.64
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.64
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Nomi Health Commercial |
$162.81
|
| Rate for Payer: PACE Senior Care Partners |
$47.16
|
| Rate for Payer: PACE SWMI |
$49.64
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Medicare Advantage |
$49.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.06
|
| Rate for Payer: Priority Health HMO/PPO |
$172.74
|
| Rate for Payer: Priority Health Medicare |
$50.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.03
|
| Rate for Payer: Railroad Medicare Medicare |
$49.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.72
|
| Rate for Payer: UHC Core |
$165.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.64
|
| Rate for Payer: UHC Exchange |
$49.64
|
| Rate for Payer: UHC Medicare Advantage |
$49.64
|
| Rate for Payer: VA VA |
$49.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$32.36
|
| Rate for Payer: Aetna Medicare |
$9.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.90
|
| Rate for Payer: BCBS Complete |
$15.23
|
| Rate for Payer: BCBS MAPPO |
$9.52
|
| Rate for Payer: BCBS Trust/PPO |
$31.30
|
| Rate for Payer: BCN Commercial |
$29.60
|
| Rate for Payer: BCN Medicare Advantage |
$9.52
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.52
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.36
|
| Rate for Payer: Nomi Health Commercial |
$31.22
|
| Rate for Payer: PACE Senior Care Partners |
$9.04
|
| Rate for Payer: PACE SWMI |
$9.52
|
| Rate for Payer: PHP Commercial |
$32.36
|
| Rate for Payer: PHP Medicare Advantage |
$9.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health HMO/PPO |
$33.12
|
| Rate for Payer: Priority Health Medicare |
$9.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$9.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.50
|
| Rate for Payer: UHC Core |
$31.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.52
|
| Rate for Payer: UHC Exchange |
$9.52
|
| Rate for Payer: UHC Medicare Advantage |
$9.52
|
| Rate for Payer: VA VA |
$9.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.55
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 00904635861
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna Medicare |
$103.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.84
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: BCBS MAPPO |
$99.88
|
| Rate for Payer: BCBS Trust/PPO |
$328.43
|
| Rate for Payer: BCN Commercial |
$310.61
|
| Rate for Payer: BCN Medicare Advantage |
$99.88
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: Nomi Health Commercial |
$327.59
|
| Rate for Payer: PACE Senior Care Partners |
$94.88
|
| Rate for Payer: PACE SWMI |
$99.88
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: PHP Medicare Advantage |
$99.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health HMO/PPO |
$347.56
|
| Rate for Payer: Priority Health Medicare |
$100.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.66
|
| Rate for Payer: Railroad Medicare Medicare |
$99.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.88
|
| Rate for Payer: UHC Exchange |
$99.88
|
| Rate for Payer: UHC Medicare Advantage |
$99.88
|
| Rate for Payer: VA VA |
$99.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
RISPERIDONE 0.5 MG TABLET
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 00904635861
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: BCBS Trust/PPO |
$326.11
|
| Rate for Payer: BCN Commercial |
$308.73
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: Nomi Health Commercial |
$327.59
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health HMO/PPO |
$347.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.56
|
| Rate for Payer: UHC Core |
$333.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$5.36
|
|
|
Service Code
|
NDC 09900000349
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: Aetna Medicare |
$1.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.68
|
| Rate for Payer: BCBS Complete |
$2.14
|
| Rate for Payer: BCBS MAPPO |
$1.34
|
| Rate for Payer: BCBS Trust/PPO |
$4.41
|
| Rate for Payer: BCN Commercial |
$4.17
|
| Rate for Payer: BCN Medicare Advantage |
$1.34
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: PACE Senior Care Partners |
$1.27
|
| Rate for Payer: PACE SWMI |
$1.34
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: PHP Medicare Advantage |
$1.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health HMO/PPO |
$4.66
|
| Rate for Payer: Priority Health Medicare |
$1.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$4.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.34
|
| Rate for Payer: UHC Exchange |
$1.34
|
| Rate for Payer: UHC Medicare Advantage |
$1.34
|
| Rate for Payer: VA VA |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.27 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.30
|
| Rate for Payer: BCBS Complete |
$37.50
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS Trust/PPO |
$77.07
|
| Rate for Payer: BCN Commercial |
$72.89
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Nomi Health Commercial |
$76.88
|
| Rate for Payer: PACE Senior Care Partners |
$22.27
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| Rate for Payer: Priority Health HMO/PPO |
$81.56
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.81
|
| Rate for Payer: Railroad Medicare Medicare |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.50
|
| Rate for Payer: UHC Core |
$78.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Exchange |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: VA VA |
$23.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$565.22
|
|
|
Service Code
|
NDC 50458030503
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.24 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: Aetna Medicare |
$146.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$176.63
|
| Rate for Payer: Amish Plain Church Group Commercial |
$176.63
|
| Rate for Payer: BCBS Complete |
$226.09
|
| Rate for Payer: BCBS MAPPO |
$141.30
|
| Rate for Payer: BCBS Trust/PPO |
$464.67
|
| Rate for Payer: BCN Commercial |
$439.46
|
| Rate for Payer: BCN Medicare Advantage |
$141.30
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.30
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.44
|
| Rate for Payer: Nomi Health Commercial |
$463.48
|
| Rate for Payer: PACE Senior Care Partners |
$134.24
|
| Rate for Payer: PACE SWMI |
$141.30
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: PHP Medicare Advantage |
$141.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.39
|
| Rate for Payer: Priority Health HMO/PPO |
$491.74
|
| Rate for Payer: Priority Health Medicare |
$142.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$378.70
|
| Rate for Payer: Railroad Medicare Medicare |
$141.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.39
|
| Rate for Payer: UHC Core |
$471.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.30
|
| Rate for Payer: UHC Exchange |
$141.30
|
| Rate for Payer: UHC Medicare Advantage |
$141.30
|
| Rate for Payer: VA VA |
$141.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$74.45
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna Commercial |
$63.28
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.27
|
| Rate for Payer: BCBS Complete |
$29.78
|
| Rate for Payer: BCBS MAPPO |
$18.61
|
| Rate for Payer: BCBS Trust/PPO |
$61.21
|
| Rate for Payer: BCN Commercial |
$57.88
|
| Rate for Payer: BCN Medicare Advantage |
$18.61
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cofinity Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.61
|
| Rate for Payer: Healthscope Commercial |
$67.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.28
|
| Rate for Payer: Nomi Health Commercial |
$61.05
|
| Rate for Payer: PACE Senior Care Partners |
$17.68
|
| Rate for Payer: PACE SWMI |
$18.61
|
| Rate for Payer: PHP Commercial |
$63.28
|
| Rate for Payer: PHP Medicare Advantage |
$18.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.39
|
| Rate for Payer: Priority Health HMO/PPO |
$64.77
|
| Rate for Payer: Priority Health Medicare |
$18.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.88
|
| Rate for Payer: Railroad Medicare Medicare |
$18.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.52
|
| Rate for Payer: UHC Core |
$62.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.61
|
| Rate for Payer: UHC Exchange |
$18.61
|
| Rate for Payer: UHC Medicare Advantage |
$18.61
|
| Rate for Payer: VA VA |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.84
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
NDC 09900001854
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.42
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS MAPPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$1.10
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.34
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.34
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PACE Senior Care Partners |
$0.32
|
| Rate for Payer: PACE SWMI |
$0.34
|
| Rate for Payer: PHP Commercial |
$1.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1.17
|
| Rate for Payer: Priority Health Medicare |
$0.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.90
|
| Rate for Payer: Railroad Medicare Medicare |
$0.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.18
|
| Rate for Payer: UHC Core |
$1.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.34
|
| Rate for Payer: UHC Exchange |
$0.34
|
| Rate for Payer: UHC Medicare Advantage |
$0.34
|
| Rate for Payer: VA VA |
$0.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.00
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$565.22
|
|
|
Service Code
|
NDC 50458030503
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.39 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: BCBS Trust/PPO |
$461.39
|
| Rate for Payer: BCN Commercial |
$436.80
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.44
|
| Rate for Payer: Nomi Health Commercial |
$463.48
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.39
|
| Rate for Payer: Priority Health HMO/PPO |
$491.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$378.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$497.39
|
| Rate for Payer: UHC Core |
$471.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$74.45
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.39 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna Commercial |
$63.28
|
| Rate for Payer: BCBS Trust/PPO |
$60.77
|
| Rate for Payer: BCN Commercial |
$57.53
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cofinity Commercial |
$64.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.56
|
| Rate for Payer: Healthscope Commercial |
$67.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.28
|
| Rate for Payer: Nomi Health Commercial |
$61.05
|
| Rate for Payer: PHP Commercial |
$63.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.39
|
| Rate for Payer: Priority Health HMO/PPO |
$64.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.52
|
| Rate for Payer: UHC Core |
$62.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.84
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
NDC 09900001854
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.09
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Cofinity Commercial |
$1.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$1.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PHP Commercial |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.18
|
| Rate for Payer: UHC Core |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.00
|
|
