|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 09900000348
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$5.36
|
|
|
Service Code
|
NDC 09900000349
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$4.82 |
| Rate for Payer: Aetna Commercial |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$4.38
|
| Rate for Payer: BCN Commercial |
$4.14
|
| Rate for Payer: Cash Price |
$4.29
|
| Rate for Payer: Cofinity Commercial |
$4.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.56
|
| Rate for Payer: Nomi Health Commercial |
$4.40
|
| Rate for Payer: PHP Commercial |
$4.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.48
|
| Rate for Payer: Priority Health HMO/PPO |
$4.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.72
|
| Rate for Payer: UHC Core |
$4.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.02
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.94 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: BCBS Trust/PPO |
$76.53
|
| Rate for Payer: BCN Commercial |
$72.45
|
| 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: Healthscope Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Nomi Health Commercial |
$76.88
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| Rate for Payer: Priority Health HMO/PPO |
$81.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.50
|
| Rate for Payer: UHC Core |
$78.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 09900000348
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: BCBS Trust/PPO |
$276.24
|
| Rate for Payer: BCN Commercial |
$261.52
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$1,684.98
|
|
|
Service Code
|
NDC 50458030001
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.18 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: Aetna Medicare |
$438.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$526.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$526.56
|
| Rate for Payer: BCBS Complete |
$673.99
|
| Rate for Payer: BCBS MAPPO |
$421.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.22
|
| Rate for Payer: BCN Commercial |
$1,310.07
|
| Rate for Payer: BCN Medicare Advantage |
$421.24
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.24
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$484.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.23
|
| Rate for Payer: Nomi Health Commercial |
$1,381.68
|
| Rate for Payer: PACE Senior Care Partners |
$400.18
|
| Rate for Payer: PACE SWMI |
$421.24
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: PHP Medicare Advantage |
$421.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1,465.93
|
| Rate for Payer: Priority Health Medicare |
$425.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.94
|
| Rate for Payer: Railroad Medicare Medicare |
$421.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,482.78
|
| Rate for Payer: UHC Core |
$1,406.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.24
|
| Rate for Payer: UHC Exchange |
$421.24
|
| Rate for Payer: UHC Medicare Advantage |
$421.24
|
| Rate for Payer: VA VA |
$421.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.74
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$1,684.98
|
|
|
Service Code
|
NDC 50458030001
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,095.24 |
| Max. Negotiated Rate |
$1,516.48 |
| Rate for Payer: Aetna Commercial |
$1,432.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,375.45
|
| Rate for Payer: BCN Commercial |
$1,302.15
|
| Rate for Payer: Cash Price |
$1,347.98
|
| Rate for Payer: Cofinity Commercial |
$1,449.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.98
|
| Rate for Payer: Healthscope Commercial |
$1,516.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,432.23
|
| Rate for Payer: Nomi Health Commercial |
$1,381.68
|
| Rate for Payer: PHP Commercial |
$1,432.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1,465.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,482.78
|
| Rate for Payer: UHC Core |
$1,406.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.74
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$87.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.75
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS MAPPO |
$84.60
|
| Rate for Payer: BCBS Trust/PPO |
$278.20
|
| Rate for Payer: BCN Commercial |
$263.11
|
| Rate for Payer: BCN Medicare Advantage |
$84.60
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: PACE Senior Care Partners |
$80.37
|
| Rate for Payer: PACE SWMI |
$84.60
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO |
$294.41
|
| Rate for Payer: Priority Health Medicare |
$85.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$226.73
|
| Rate for Payer: Railroad Medicare Medicare |
$84.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.79
|
| Rate for Payer: UHC Core |
$282.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.60
|
| Rate for Payer: UHC Exchange |
$84.60
|
| Rate for Payer: UHC Medicare Advantage |
$84.60
|
| Rate for Payer: VA VA |
$84.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE MICROSPHERES ER 12.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS
|
Facility
|
OP
|
$994.29
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
81838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$894.86 |
| Rate for Payer: Aetna Commercial |
$845.15
|
| Rate for Payer: Aetna Medicare |
$258.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$310.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$310.72
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: BCBS MAPPO |
$248.57
|
| Rate for Payer: BCBS Trust/PPO |
$817.41
|
| Rate for Payer: BCN Commercial |
$773.06
|
| Rate for Payer: BCN Medicare Advantage |
$248.57
|
| Rate for Payer: Cash Price |
$795.43
|
| Rate for Payer: Cash Price |
$795.43
|
| Rate for Payer: Cofinity Commercial |
$855.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.57
|
| Rate for Payer: Healthscope Commercial |
$894.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.72
|
| Rate for Payer: Mclaren Medicaid |
$7.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.00
|
| Rate for Payer: Meridian Medicaid |
$8.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$285.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.15
|
| Rate for Payer: Nomi Health Commercial |
$815.32
|
| Rate for Payer: PACE Senior Care Partners |
$236.14
|
| Rate for Payer: PACE SWMI |
$248.57
|
| Rate for Payer: PHP Commercial |
$845.15
|
| Rate for Payer: PHP Medicare Advantage |
$248.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.29
|
| Rate for Payer: Priority Health HMO/PPO |
$865.03
|
| Rate for Payer: Priority Health Medicare |
$251.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.17
|
| Rate for Payer: Railroad Medicare Medicare |
$248.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$874.98
|
| Rate for Payer: UHC Core |
$830.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.57
|
| Rate for Payer: UHC Exchange |
$248.57
|
| Rate for Payer: UHC Medicare Advantage |
$248.57
|
| Rate for Payer: UHCCP Medicaid |
$7.95
|
| Rate for Payer: VA VA |
$248.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.72
|
|
|
RISPERIDONE MICROSPHERES ER 12.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS
|
Facility
|
IP
|
$994.29
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
81838
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$646.29 |
| Max. Negotiated Rate |
$894.86 |
| Rate for Payer: Aetna Commercial |
$845.15
|
| Rate for Payer: BCBS Trust/PPO |
$811.64
|
| Rate for Payer: BCN Commercial |
$768.39
|
| Rate for Payer: Cash Price |
$795.43
|
| Rate for Payer: Cofinity Commercial |
$855.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$795.43
|
| Rate for Payer: Healthscope Commercial |
$894.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$745.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.15
|
| Rate for Payer: Nomi Health Commercial |
$815.32
|
| Rate for Payer: PHP Commercial |
$845.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.29
|
| Rate for Payer: Priority Health HMO/PPO |
$865.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$666.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$874.98
|
| Rate for Payer: UHC Core |
$830.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$745.72
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
OP
|
$1,792.36
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$1,613.12 |
| Rate for Payer: Aetna Commercial |
$1,523.51
|
| Rate for Payer: Aetna Medicare |
$466.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$560.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$560.11
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: BCBS MAPPO |
$448.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,473.50
|
| Rate for Payer: BCN Commercial |
$1,393.56
|
| Rate for Payer: BCN Medicare Advantage |
$448.09
|
| Rate for Payer: Cash Price |
$1,433.89
|
| Rate for Payer: Cash Price |
$1,433.89
|
| Rate for Payer: Cofinity Commercial |
$1,541.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$448.09
|
| Rate for Payer: Healthscope Commercial |
$1,613.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.27
|
| Rate for Payer: Mclaren Medicaid |
$7.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$470.49
|
| Rate for Payer: Meridian Medicaid |
$8.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$515.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.51
|
| Rate for Payer: Nomi Health Commercial |
$1,469.74
|
| Rate for Payer: PACE Senior Care Partners |
$425.69
|
| Rate for Payer: PACE SWMI |
$448.09
|
| Rate for Payer: PHP Commercial |
$1,523.51
|
| Rate for Payer: PHP Medicare Advantage |
$448.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.35
|
| Rate for Payer: Priority Health Medicare |
$452.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.88
|
| Rate for Payer: Railroad Medicare Medicare |
$448.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.28
|
| Rate for Payer: UHC Core |
$1,496.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$448.09
|
| Rate for Payer: UHC Exchange |
$448.09
|
| Rate for Payer: UHC Medicare Advantage |
$448.09
|
| Rate for Payer: UHCCP Medicaid |
$7.95
|
| Rate for Payer: VA VA |
$448.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.27
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
IP
|
$1,792.36
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,165.03 |
| Max. Negotiated Rate |
$1,613.12 |
| Rate for Payer: Aetna Commercial |
$1,523.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,463.10
|
| Rate for Payer: BCN Commercial |
$1,385.14
|
| Rate for Payer: Cash Price |
$1,433.89
|
| Rate for Payer: Cofinity Commercial |
$1,541.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.89
|
| Rate for Payer: Healthscope Commercial |
$1,613.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,344.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.51
|
| Rate for Payer: Nomi Health Commercial |
$1,469.74
|
| Rate for Payer: PHP Commercial |
$1,523.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1,559.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.28
|
| Rate for Payer: UHC Core |
$1,496.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,344.27
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.45
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.20
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.76
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: PACE Senior Care Partners |
$1.67
|
| Rate for Payer: PACE SWMI |
$1.76
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Medicare |
$1.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.76
|
| Rate for Payer: UHC Exchange |
$1.76
|
| Rate for Payer: UHC Medicare Advantage |
$1.76
|
| Rate for Payer: VA VA |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$5.75
|
| Rate for Payer: BCN Commercial |
$5.45
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.20
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.76
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: PACE Senior Care Partners |
$1.67
|
| Rate for Payer: PACE SWMI |
$1.76
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Medicare |
$1.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.76
|
| Rate for Payer: UHC Exchange |
$1.76
|
| Rate for Payer: UHC Medicare Advantage |
$1.76
|
| Rate for Payer: VA VA |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$279.08
|
|
|
Service Code
|
NDC 51991079306
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: BCBS Trust/PPO |
$227.81
|
| Rate for Payer: BCN Commercial |
$215.67
|
| Rate for Payer: Cash Price |
$223.26
|
| Rate for Payer: Cofinity Commercial |
$240.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.26
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.22
|
| Rate for Payer: Nomi Health Commercial |
$228.85
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.40
|
| Rate for Payer: Priority Health HMO/PPO |
$242.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.59
|
| Rate for Payer: UHC Core |
$233.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.31
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.22 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: BCBS Trust/PPO |
$107.02
|
| Rate for Payer: BCN Commercial |
$101.31
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Nomi Health Commercial |
$107.50
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health HMO/PPO |
$114.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.37
|
| Rate for Payer: UHC Core |
$109.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.32
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$159.56
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.90 |
| Max. Negotiated Rate |
$143.60 |
| Rate for Payer: Aetna Commercial |
$135.63
|
| Rate for Payer: Aetna Medicare |
$41.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.86
|
| Rate for Payer: BCBS Complete |
$63.82
|
| Rate for Payer: BCBS MAPPO |
$39.89
|
| Rate for Payer: BCBS Trust/PPO |
$131.17
|
| Rate for Payer: BCN Commercial |
$124.06
|
| Rate for Payer: BCN Medicare Advantage |
$39.89
|
| Rate for Payer: Cash Price |
$127.65
|
| Rate for Payer: Cofinity Commercial |
$137.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.89
|
| Rate for Payer: Healthscope Commercial |
$143.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.63
|
| Rate for Payer: Nomi Health Commercial |
$130.84
|
| Rate for Payer: PACE Senior Care Partners |
$37.90
|
| Rate for Payer: PACE SWMI |
$39.89
|
| Rate for Payer: PHP Commercial |
$135.63
|
| Rate for Payer: PHP Medicare Advantage |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.71
|
| Rate for Payer: Priority Health HMO/PPO |
$138.82
|
| Rate for Payer: Priority Health Medicare |
$40.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.91
|
| Rate for Payer: Railroad Medicare Medicare |
$39.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.41
|
| Rate for Payer: UHC Core |
$133.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.89
|
| Rate for Payer: UHC Exchange |
$39.89
|
| Rate for Payer: UHC Medicare Advantage |
$39.89
|
| Rate for Payer: VA VA |
$39.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.67
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$279.08
|
|
|
Service Code
|
NDC 51991079306
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.28 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: Aetna Medicare |
$72.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.21
|
| Rate for Payer: BCBS Complete |
$111.63
|
| Rate for Payer: BCBS MAPPO |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$229.43
|
| Rate for Payer: BCN Commercial |
$216.98
|
| Rate for Payer: BCN Medicare Advantage |
$69.77
|
| Rate for Payer: Cash Price |
$223.26
|
| Rate for Payer: Cofinity Commercial |
$240.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.77
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.22
|
| Rate for Payer: Nomi Health Commercial |
$228.85
|
| Rate for Payer: PACE Senior Care Partners |
$66.28
|
| Rate for Payer: PACE SWMI |
$69.77
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: PHP Medicare Advantage |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.40
|
| Rate for Payer: Priority Health HMO/PPO |
$242.80
|
| Rate for Payer: Priority Health Medicare |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.98
|
| Rate for Payer: Railroad Medicare Medicare |
$69.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.59
|
| Rate for Payer: UHC Core |
$233.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.77
|
| Rate for Payer: UHC Exchange |
$69.77
|
| Rate for Payer: UHC Medicare Advantage |
$69.77
|
| Rate for Payer: VA VA |
$69.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.31
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$34.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.97
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: BCBS MAPPO |
$32.78
|
| Rate for Payer: BCBS Trust/PPO |
$107.78
|
| Rate for Payer: BCN Commercial |
$101.93
|
| Rate for Payer: BCN Medicare Advantage |
$32.78
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Nomi Health Commercial |
$107.50
|
| Rate for Payer: PACE Senior Care Partners |
$31.14
|
| Rate for Payer: PACE SWMI |
$32.78
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: PHP Medicare Advantage |
$32.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health HMO/PPO |
$114.06
|
| Rate for Payer: Priority Health Medicare |
$33.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.84
|
| Rate for Payer: Railroad Medicare Medicare |
$32.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.37
|
| Rate for Payer: UHC Core |
$109.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.78
|
| Rate for Payer: UHC Exchange |
$32.78
|
| Rate for Payer: UHC Medicare Advantage |
$32.78
|
| Rate for Payer: VA VA |
$32.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.32
|
|
