|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
IP
|
$159.80
|
|
|
Service Code
|
NDC 43547026910
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: BCBS Trust/PPO |
$130.44
|
| Rate for Payer: BCN Commercial |
$123.49
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health HMO/PPO |
$139.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.62
|
| Rate for Payer: UHC Core |
$133.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
|
OP
|
$159.80
|
|
|
Service Code
|
NDC 43547026910
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$143.82 |
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Medicare |
$41.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.94
|
| Rate for Payer: BCBS Complete |
$63.92
|
| Rate for Payer: BCBS MAPPO |
$39.95
|
| Rate for Payer: BCBS Trust/PPO |
$131.37
|
| Rate for Payer: BCN Commercial |
$124.24
|
| Rate for Payer: BCN Medicare Advantage |
$39.95
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.95
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.83
|
| Rate for Payer: Nomi Health Commercial |
$131.04
|
| Rate for Payer: PACE Senior Care Partners |
$37.95
|
| Rate for Payer: PACE SWMI |
$39.95
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: PHP Medicare Advantage |
$39.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.87
|
| Rate for Payer: Priority Health HMO/PPO |
$139.03
|
| Rate for Payer: Priority Health Medicare |
$40.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.07
|
| Rate for Payer: Railroad Medicare Medicare |
$39.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.62
|
| Rate for Payer: UHC Core |
$133.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.95
|
| Rate for Payer: UHC Exchange |
$39.95
|
| Rate for Payer: UHC Medicare Advantage |
$39.95
|
| Rate for Payer: VA VA |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.85
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
NDC 60687058801
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.06 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$100.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.12
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: BCBS MAPPO |
$96.90
|
| Rate for Payer: BCBS Trust/PPO |
$318.65
|
| Rate for Payer: BCN Commercial |
$301.36
|
| Rate for Payer: BCN Medicare Advantage |
$96.90
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.90
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$317.83
|
| Rate for Payer: PACE Senior Care Partners |
$92.06
|
| Rate for Payer: PACE SWMI |
$96.90
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: PHP Medicare Advantage |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health HMO/PPO |
$337.21
|
| Rate for Payer: Priority Health Medicare |
$97.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.69
|
| Rate for Payer: Railroad Medicare Medicare |
$96.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.90
|
| Rate for Payer: UHC Exchange |
$96.90
|
| Rate for Payer: UHC Medicare Advantage |
$96.90
|
| Rate for Payer: VA VA |
$96.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 43547027010
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$171.32 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: Aetna Medicare |
$49.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.48
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS MAPPO |
$47.59
|
| Rate for Payer: BCBS Trust/PPO |
$156.49
|
| Rate for Payer: BCN Commercial |
$148.00
|
| Rate for Payer: BCN Medicare Advantage |
$47.59
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.59
|
| Rate for Payer: Healthscope Commercial |
$171.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: PACE Senior Care Partners |
$45.21
|
| Rate for Payer: PACE SWMI |
$47.59
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO |
$165.60
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.53
|
| Rate for Payer: Railroad Medicare Medicare |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.51
|
| Rate for Payer: UHC Core |
$158.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.59
|
| Rate for Payer: UHC Exchange |
$47.59
|
| Rate for Payer: UHC Medicare Advantage |
$47.59
|
| Rate for Payer: VA VA |
$47.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.03 |
| Max. Negotiated Rate |
$324.04 |
| Rate for Payer: Aetna Commercial |
$306.04
|
| Rate for Payer: BCBS Trust/PPO |
$293.91
|
| Rate for Payer: BCN Commercial |
$278.25
|
| Rate for Payer: Cash Price |
$288.04
|
| Rate for Payer: Cofinity Commercial |
$309.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.04
|
| Rate for Payer: Healthscope Commercial |
$324.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.04
|
| Rate for Payer: Nomi Health Commercial |
$295.24
|
| Rate for Payer: PHP Commercial |
$306.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.03
|
| Rate for Payer: Priority Health HMO/PPO |
$313.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.84
|
| Rate for Payer: UHC Core |
$300.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.04
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 43547027010
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$171.32 |
| Rate for Payer: Aetna Commercial |
$161.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.38
|
| Rate for Payer: BCN Commercial |
$147.10
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$163.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$171.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: PHP Commercial |
$161.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.73
|
| Rate for Payer: Priority Health HMO/PPO |
$165.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.51
|
| Rate for Payer: UHC Core |
$158.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.76
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 60687058811
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 60687058801
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.94 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: BCBS Trust/PPO |
$316.40
|
| Rate for Payer: BCN Commercial |
$299.54
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: Nomi Health Commercial |
$317.83
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health HMO/PPO |
$337.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$259.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.09
|
| Rate for Payer: UHC Core |
$323.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.70
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$3.88
|
|
|
Service Code
|
NDC 60687058811
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.49 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.91
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$324.04 |
| Rate for Payer: Aetna Commercial |
$306.04
|
| Rate for Payer: Aetna Medicare |
$93.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.52
|
| Rate for Payer: BCBS Complete |
$144.02
|
| Rate for Payer: BCBS MAPPO |
$90.01
|
| Rate for Payer: BCBS Trust/PPO |
$296.00
|
| Rate for Payer: BCN Commercial |
$279.94
|
| Rate for Payer: BCN Medicare Advantage |
$90.01
|
| Rate for Payer: Cash Price |
$288.04
|
| Rate for Payer: Cofinity Commercial |
$309.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.01
|
| Rate for Payer: Healthscope Commercial |
$324.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.04
|
| Rate for Payer: Nomi Health Commercial |
$295.24
|
| Rate for Payer: PACE Senior Care Partners |
$85.51
|
| Rate for Payer: PACE SWMI |
$90.01
|
| Rate for Payer: PHP Commercial |
$306.04
|
| Rate for Payer: PHP Medicare Advantage |
$90.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.03
|
| Rate for Payer: Priority Health HMO/PPO |
$313.24
|
| Rate for Payer: Priority Health Medicare |
$90.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.23
|
| Rate for Payer: Railroad Medicare Medicare |
$90.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.84
|
| Rate for Payer: UHC Core |
$300.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.01
|
| Rate for Payer: UHC Exchange |
$90.01
|
| Rate for Payer: UHC Medicare Advantage |
$90.01
|
| Rate for Payer: VA VA |
$90.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.04
|
|
|
ROPINIROLE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$222.45
|
|
|
Service Code
|
NDC 00228365803
|
| Hospital Charge Code |
92015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.52
|
| Rate for Payer: BCBS Complete |
$88.98
|
| Rate for Payer: BCBS MAPPO |
$55.61
|
| Rate for Payer: BCBS Trust/PPO |
$182.88
|
| Rate for Payer: BCN Commercial |
$172.95
|
| Rate for Payer: BCN Medicare Advantage |
$55.61
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.61
|
| Rate for Payer: Healthscope Commercial |
$200.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.08
|
| Rate for Payer: Nomi Health Commercial |
$182.41
|
| Rate for Payer: PACE Senior Care Partners |
$52.83
|
| Rate for Payer: PACE SWMI |
$55.61
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: PHP Medicare Advantage |
$55.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.59
|
| Rate for Payer: Priority Health HMO/PPO |
$193.53
|
| Rate for Payer: Priority Health Medicare |
$56.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.04
|
| Rate for Payer: Railroad Medicare Medicare |
$55.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.61
|
| Rate for Payer: UHC Exchange |
$55.61
|
| Rate for Payer: UHC Medicare Advantage |
$55.61
|
| Rate for Payer: VA VA |
$55.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
ROPINIROLE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$222.45
|
|
|
Service Code
|
NDC 00228365803
|
| Hospital Charge Code |
92015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: BCBS Trust/PPO |
$181.59
|
| Rate for Payer: BCN Commercial |
$171.91
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Healthscope Commercial |
$200.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.08
|
| Rate for Payer: Nomi Health Commercial |
$182.41
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.59
|
| Rate for Payer: Priority Health HMO/PPO |
$193.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$87.41
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$78.67 |
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Commercial |
$82.43
|
| Rate for Payer: BCBS Trust/PPO |
$71.35
|
| Rate for Payer: BCBS Trust/PPO |
$79.16
|
| Rate for Payer: BCBS Trust/PPO |
$45.31
|
| Rate for Payer: BCBS Trust/PPO |
$41.93
|
| Rate for Payer: BCN Commercial |
$67.55
|
| Rate for Payer: BCN Commercial |
$39.69
|
| Rate for Payer: BCN Commercial |
$74.95
|
| Rate for Payer: BCN Commercial |
$42.90
|
| Rate for Payer: Cash Price |
$44.41
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$77.58
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: Cofinity Commercial |
$44.17
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$47.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.58
|
| Rate for Payer: Healthscope Commercial |
$87.28
|
| Rate for Payer: Healthscope Commercial |
$49.96
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$46.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.43
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| Rate for Payer: Nomi Health Commercial |
$45.52
|
| Rate for Payer: Nomi Health Commercial |
$79.52
|
| Rate for Payer: Nomi Health Commercial |
$71.68
|
| Rate for Payer: PHP Commercial |
$47.18
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.82
|
| Rate for Payer: Priority Health HMO/PPO |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO |
$84.37
|
| Rate for Payer: Priority Health HMO/PPO |
$44.68
|
| Rate for Payer: Priority Health HMO/PPO |
$48.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.92
|
| Rate for Payer: UHC Core |
$72.99
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Core |
$46.35
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$51.36
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Commercial |
$82.43
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna Medicare |
$22.73
|
| Rate for Payer: Aetna Medicare |
$25.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.05
|
| Rate for Payer: BCBS Complete |
$20.54
|
| Rate for Payer: BCBS Complete |
$22.20
|
| Rate for Payer: BCBS Complete |
$38.79
|
| Rate for Payer: BCBS Complete |
$34.96
|
| Rate for Payer: BCBS MAPPO |
$12.84
|
| Rate for Payer: BCBS MAPPO |
$13.88
|
| Rate for Payer: BCBS MAPPO |
$24.24
|
| Rate for Payer: BCBS MAPPO |
$21.85
|
| Rate for Payer: BCBS Trust/PPO |
$42.22
|
| Rate for Payer: BCBS Trust/PPO |
$79.73
|
| Rate for Payer: BCBS Trust/PPO |
$45.63
|
| Rate for Payer: BCBS Trust/PPO |
$71.86
|
| Rate for Payer: BCN Commercial |
$39.93
|
| Rate for Payer: BCN Commercial |
$67.96
|
| Rate for Payer: BCN Commercial |
$43.16
|
| Rate for Payer: BCN Commercial |
$75.40
|
| Rate for Payer: BCN Medicare Advantage |
$13.88
|
| Rate for Payer: BCN Medicare Advantage |
$24.24
|
| Rate for Payer: BCN Medicare Advantage |
$12.84
|
| Rate for Payer: BCN Medicare Advantage |
$21.85
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: Cash Price |
$77.58
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$44.41
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Cofinity Commercial |
$47.74
|
| Rate for Payer: Cofinity Commercial |
$44.17
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.85
|
| Rate for Payer: Healthscope Commercial |
$46.22
|
| Rate for Payer: Healthscope Commercial |
$87.28
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$49.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.30
|
| Rate for Payer: Nomi Health Commercial |
$71.68
|
| Rate for Payer: Nomi Health Commercial |
$79.52
|
| Rate for Payer: Nomi Health Commercial |
$42.12
|
| Rate for Payer: Nomi Health Commercial |
$45.52
|
| Rate for Payer: PACE Senior Care Partners |
$12.20
|
| Rate for Payer: PACE Senior Care Partners |
$20.76
|
| Rate for Payer: PACE Senior Care Partners |
$23.03
|
| Rate for Payer: PACE Senior Care Partners |
$13.18
|
| Rate for Payer: PACE SWMI |
$13.88
|
| Rate for Payer: PACE SWMI |
$12.84
|
| Rate for Payer: PACE SWMI |
$21.85
|
| Rate for Payer: PACE SWMI |
$24.24
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: PHP Commercial |
$82.43
|
| Rate for Payer: PHP Commercial |
$47.18
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: PHP Medicare Advantage |
$13.88
|
| Rate for Payer: PHP Medicare Advantage |
$12.84
|
| Rate for Payer: PHP Medicare Advantage |
$24.24
|
| Rate for Payer: PHP Medicare Advantage |
$21.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.38
|
| Rate for Payer: Priority Health HMO/PPO |
$48.29
|
| Rate for Payer: Priority Health HMO/PPO |
$84.37
|
| Rate for Payer: Priority Health HMO/PPO |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO |
$44.68
|
| Rate for Payer: Priority Health Medicare |
$22.07
|
| Rate for Payer: Priority Health Medicare |
$12.97
|
| Rate for Payer: Priority Health Medicare |
$14.02
|
| Rate for Payer: Priority Health Medicare |
$24.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13.88
|
| Rate for Payer: Railroad Medicare Medicare |
$21.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.84
|
| Rate for Payer: Railroad Medicare Medicare |
$24.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.85
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: UHC Core |
$46.35
|
| Rate for Payer: UHC Core |
$72.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.88
|
| Rate for Payer: UHC Exchange |
$24.24
|
| Rate for Payer: UHC Exchange |
$13.88
|
| Rate for Payer: UHC Exchange |
$12.84
|
| Rate for Payer: UHC Exchange |
$21.85
|
| Rate for Payer: UHC Medicare Advantage |
$24.24
|
| Rate for Payer: UHC Medicare Advantage |
$12.84
|
| Rate for Payer: UHC Medicare Advantage |
$21.85
|
| Rate for Payer: UHC Medicare Advantage |
$13.88
|
| Rate for Payer: VA VA |
$13.88
|
| Rate for Payer: VA VA |
$24.24
|
| Rate for Payer: VA VA |
$21.85
|
| Rate for Payer: VA VA |
$12.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$28.44
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna Commercial |
$24.91
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: BCBS Trust/PPO |
$23.56
|
| Rate for Payer: BCBS Trust/PPO |
$20.30
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.05
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$16.68
|
| Rate for Payer: BCBS Trust/PPO |
$19.95
|
| Rate for Payer: BCBS Trust/PPO |
$16.78
|
| Rate for Payer: BCN Commercial |
$15.89
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: BCN Commercial |
$15.79
|
| Rate for Payer: BCN Commercial |
$21.98
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Commercial |
$22.30
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$26.38
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Nomi Health Commercial |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$23.32
|
| Rate for Payer: Nomi Health Commercial |
$24.03
|
| Rate for Payer: Nomi Health Commercial |
$13.11
|
| Rate for Payer: Nomi Health Commercial |
$16.75
|
| Rate for Payer: Nomi Health Commercial |
$20.04
|
| Rate for Payer: Nomi Health Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$24.91
|
| Rate for Payer: PHP Commercial |
$13.59
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.05
|
| Rate for Payer: Priority Health HMO/PPO |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO |
$24.74
|
| Rate for Payer: Priority Health HMO/PPO |
$17.77
|
| Rate for Payer: Priority Health HMO/PPO |
$13.91
|
| Rate for Payer: Priority Health HMO/PPO |
$21.26
|
| Rate for Payer: Priority Health HMO/PPO |
$25.11
|
| Rate for Payer: Priority Health HMO/PPO |
$17.89
|
| Rate for Payer: Priority Health HMO/PPO |
$25.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.98
|
| Rate for Payer: UHC Core |
$20.41
|
| Rate for Payer: UHC Core |
$13.35
|
| Rate for Payer: UHC Core |
$23.75
|
| Rate for Payer: UHC Core |
$17.06
|
| Rate for Payer: UHC Core |
$20.77
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Core |
$24.10
|
| Rate for Payer: UHC Core |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.65
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.99
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$24.91
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna Medicare |
$7.50
|
| Rate for Payer: Aetna Medicare |
$5.35
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Aetna Medicare |
$4.16
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS Complete |
$8.17
|
| Rate for Payer: BCBS Complete |
$8.22
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$11.72
|
| Rate for Payer: BCBS MAPPO |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$6.22
|
| Rate for Payer: BCBS MAPPO |
$7.11
|
| Rate for Payer: BCBS MAPPO |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$7.22
|
| Rate for Payer: BCBS MAPPO |
$6.11
|
| Rate for Payer: BCBS MAPPO |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$20.09
|
| Rate for Payer: BCBS Trust/PPO |
$24.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.45
|
| Rate for Payer: BCBS Trust/PPO |
$13.15
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$23.73
|
| Rate for Payer: BCN Commercial |
$22.79
|
| Rate for Payer: BCN Commercial |
$19.00
|
| Rate for Payer: BCN Commercial |
$15.88
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: BCN Commercial |
$19.34
|
| Rate for Payer: BCN Commercial |
$22.44
|
| Rate for Payer: BCN Commercial |
$12.43
|
| Rate for Payer: BCN Commercial |
$15.99
|
| Rate for Payer: BCN Medicare Advantage |
$6.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.22
|
| Rate for Payer: BCN Medicare Advantage |
$5.14
|
| Rate for Payer: BCN Medicare Advantage |
$4.00
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.11
|
| Rate for Payer: BCN Medicare Advantage |
$6.11
|
| Rate for Payer: BCN Medicare Advantage |
$5.11
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$19.90
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$21.39
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$26.38
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.59
|
| Rate for Payer: Nomi Health Commercial |
$16.75
|
| Rate for Payer: Nomi Health Commercial |
$23.32
|
| Rate for Payer: Nomi Health Commercial |
$20.04
|
| Rate for Payer: Nomi Health Commercial |
$16.86
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Nomi Health Commercial |
$24.03
|
| Rate for Payer: Nomi Health Commercial |
$13.11
|
| Rate for Payer: Nomi Health Commercial |
$20.39
|
| Rate for Payer: PACE Senior Care Partners |
$6.96
|
| Rate for Payer: PACE Senior Care Partners |
$3.80
|
| Rate for Payer: PACE Senior Care Partners |
$5.80
|
| Rate for Payer: PACE Senior Care Partners |
$6.75
|
| Rate for Payer: PACE Senior Care Partners |
$5.91
|
| Rate for Payer: PACE Senior Care Partners |
$6.85
|
| Rate for Payer: PACE Senior Care Partners |
$4.88
|
| Rate for Payer: PACE Senior Care Partners |
$4.85
|
| Rate for Payer: PACE SWMI |
$6.22
|
| Rate for Payer: PACE SWMI |
$4.00
|
| Rate for Payer: PACE SWMI |
$5.14
|
| Rate for Payer: PACE SWMI |
$6.11
|
| Rate for Payer: PACE SWMI |
$5.11
|
| Rate for Payer: PACE SWMI |
$7.11
|
| Rate for Payer: PACE SWMI |
$7.22
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$24.91
|
| Rate for Payer: PHP Commercial |
$13.59
|
| Rate for Payer: PHP Commercial |
$21.14
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Medicare Advantage |
$7.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.11
|
| Rate for Payer: PHP Medicare Advantage |
$5.11
|
| Rate for Payer: PHP Medicare Advantage |
$6.22
|
| Rate for Payer: PHP Medicare Advantage |
$5.14
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: PHP Medicare Advantage |
$7.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.05
|
| Rate for Payer: Priority Health HMO/PPO |
$25.50
|
| Rate for Payer: Priority Health HMO/PPO |
$21.64
|
| Rate for Payer: Priority Health HMO/PPO |
$21.26
|
| Rate for Payer: Priority Health HMO/PPO |
$24.74
|
| Rate for Payer: Priority Health HMO/PPO |
$13.91
|
| Rate for Payer: Priority Health HMO/PPO |
$17.77
|
| Rate for Payer: Priority Health HMO/PPO |
$25.11
|
| Rate for Payer: Priority Health HMO/PPO |
$17.89
|
| Rate for Payer: Priority Health Medicare |
$7.40
|
| Rate for Payer: Priority Health Medicare |
$6.28
|
| Rate for Payer: Priority Health Medicare |
$6.17
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health Medicare |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$7.18
|
| Rate for Payer: Priority Health Medicare |
$7.29
|
| Rate for Payer: Priority Health Medicare |
$5.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7.22
|
| Rate for Payer: Railroad Medicare Medicare |
$7.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6.11
|
| Rate for Payer: Railroad Medicare Medicare |
$6.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.79
|
| Rate for Payer: UHC Core |
$20.77
|
| Rate for Payer: UHC Core |
$17.06
|
| Rate for Payer: UHC Core |
$23.75
|
| Rate for Payer: UHC Core |
$13.35
|
| Rate for Payer: UHC Core |
$17.17
|
| Rate for Payer: UHC Core |
$20.41
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: UHC Core |
$24.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.22
|
| Rate for Payer: UHC Exchange |
$7.11
|
| Rate for Payer: UHC Exchange |
$5.14
|
| Rate for Payer: UHC Exchange |
$7.22
|
| Rate for Payer: UHC Exchange |
$5.11
|
| Rate for Payer: UHC Exchange |
$4.00
|
| Rate for Payer: UHC Exchange |
$6.22
|
| Rate for Payer: UHC Exchange |
$6.11
|
| Rate for Payer: UHC Exchange |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$5.11
|
| Rate for Payer: UHC Medicare Advantage |
$7.11
|
| Rate for Payer: UHC Medicare Advantage |
$7.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.22
|
| Rate for Payer: UHC Medicare Advantage |
$6.11
|
| Rate for Payer: UHC Medicare Advantage |
$5.14
|
| Rate for Payer: UHC Medicare Advantage |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$4.00
|
| Rate for Payer: VA VA |
$7.22
|
| Rate for Payer: VA VA |
$6.22
|
| Rate for Payer: VA VA |
$5.11
|
| Rate for Payer: VA VA |
$6.11
|
| Rate for Payer: VA VA |
$4.00
|
| Rate for Payer: VA VA |
$7.33
|
| Rate for Payer: VA VA |
$7.11
|
| Rate for Payer: VA VA |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.99
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$493.44
|
|
|
Service Code
|
NDC 00904677961
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.19 |
| Max. Negotiated Rate |
$444.10 |
| Rate for Payer: Aetna Commercial |
$419.42
|
| Rate for Payer: Aetna Medicare |
$128.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$154.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$154.20
|
| Rate for Payer: BCBS Complete |
$197.38
|
| Rate for Payer: BCBS MAPPO |
$123.36
|
| Rate for Payer: BCBS Trust/PPO |
$405.66
|
| Rate for Payer: BCN Commercial |
$383.65
|
| Rate for Payer: BCN Medicare Advantage |
$123.36
|
| Rate for Payer: Cash Price |
$394.75
|
| Rate for Payer: Cofinity Commercial |
$424.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.36
|
| Rate for Payer: Healthscope Commercial |
$444.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.42
|
| Rate for Payer: Nomi Health Commercial |
$404.62
|
| Rate for Payer: PACE Senior Care Partners |
$117.19
|
| Rate for Payer: PACE SWMI |
$123.36
|
| Rate for Payer: PHP Commercial |
$419.42
|
| Rate for Payer: PHP Medicare Advantage |
$123.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.74
|
| Rate for Payer: Priority Health HMO/PPO |
$429.29
|
| Rate for Payer: Priority Health Medicare |
$124.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.60
|
| Rate for Payer: Railroad Medicare Medicare |
$123.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.23
|
| Rate for Payer: UHC Core |
$412.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.36
|
| Rate for Payer: UHC Exchange |
$123.36
|
| Rate for Payer: UHC Medicare Advantage |
$123.36
|
| Rate for Payer: VA VA |
$123.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.08
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$493.44
|
|
|
Service Code
|
NDC 00904677961
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.74 |
| Max. Negotiated Rate |
$444.10 |
| Rate for Payer: Aetna Commercial |
$419.42
|
| Rate for Payer: BCBS Trust/PPO |
$402.80
|
| Rate for Payer: BCN Commercial |
$381.33
|
| Rate for Payer: Cash Price |
$394.75
|
| Rate for Payer: Cofinity Commercial |
$424.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.75
|
| Rate for Payer: Healthscope Commercial |
$444.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$370.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.42
|
| Rate for Payer: Nomi Health Commercial |
$404.62
|
| Rate for Payer: PHP Commercial |
$419.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.74
|
| Rate for Payer: Priority Health HMO/PPO |
$429.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.23
|
| Rate for Payer: UHC Core |
$412.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$370.08
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$502.56
|
|
|
Service Code
|
NDC 60687025601
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.36 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: Aetna Medicare |
$130.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.05
|
| Rate for Payer: BCBS Complete |
$201.02
|
| Rate for Payer: BCBS MAPPO |
$125.64
|
| Rate for Payer: BCBS Trust/PPO |
$413.15
|
| Rate for Payer: BCN Commercial |
$390.74
|
| Rate for Payer: BCN Medicare Advantage |
$125.64
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.64
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.18
|
| Rate for Payer: Nomi Health Commercial |
$412.10
|
| Rate for Payer: PACE Senior Care Partners |
$119.36
|
| Rate for Payer: PACE SWMI |
$125.64
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: PHP Medicare Advantage |
$125.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.66
|
| Rate for Payer: Priority Health HMO/PPO |
$437.23
|
| Rate for Payer: Priority Health Medicare |
$126.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.72
|
| Rate for Payer: Railroad Medicare Medicare |
$125.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.25
|
| Rate for Payer: UHC Core |
$419.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.64
|
| Rate for Payer: UHC Exchange |
$125.64
|
| Rate for Payer: UHC Medicare Advantage |
$125.64
|
| Rate for Payer: VA VA |
$125.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.92
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$5.03
|
|
|
Service Code
|
NDC 60687025611
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: BCBS Trust/PPO |
$4.11
|
| Rate for Payer: BCN Commercial |
$3.89
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.02
|
| Rate for Payer: Healthscope Commercial |
$4.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Nomi Health Commercial |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.27
|
| Rate for Payer: Priority Health HMO/PPO |
$4.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.43
|
| Rate for Payer: UHC Core |
$4.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.77
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$5.03
|
|
|
Service Code
|
NDC 60687025611
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.57
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$1.26
|
| Rate for Payer: BCBS Trust/PPO |
$4.14
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: BCN Medicare Advantage |
$1.26
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$4.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: Nomi Health Commercial |
$4.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.19
|
| Rate for Payer: PACE SWMI |
$1.26
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: PHP Medicare Advantage |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.27
|
| Rate for Payer: Priority Health HMO/PPO |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$1.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.43
|
| Rate for Payer: UHC Core |
$4.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.26
|
| Rate for Payer: UHC Exchange |
$1.26
|
| Rate for Payer: UHC Medicare Advantage |
$1.26
|
| Rate for Payer: VA VA |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.77
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$502.56
|
|
|
Service Code
|
NDC 60687025601
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.66 |
| Max. Negotiated Rate |
$452.30 |
| Rate for Payer: Aetna Commercial |
$427.18
|
| Rate for Payer: BCBS Trust/PPO |
$410.24
|
| Rate for Payer: BCN Commercial |
$388.38
|
| Rate for Payer: Cash Price |
$402.05
|
| Rate for Payer: Cofinity Commercial |
$432.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.05
|
| Rate for Payer: Healthscope Commercial |
$452.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.18
|
| Rate for Payer: Nomi Health Commercial |
$412.10
|
| Rate for Payer: PHP Commercial |
$427.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.66
|
| Rate for Payer: Priority Health HMO/PPO |
$437.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.25
|
| Rate for Payer: UHC Core |
$419.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.92
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.86 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: BCBS Trust/PPO |
$91.51
|
| Rate for Payer: BCN Commercial |
$86.63
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health HMO/PPO |
$97.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.65
|
| Rate for Payer: UHC Core |
$93.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$29.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.03
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: BCBS MAPPO |
$28.02
|
| Rate for Payer: BCBS Trust/PPO |
$92.16
|
| Rate for Payer: BCN Commercial |
$87.16
|
| Rate for Payer: BCN Medicare Advantage |
$28.02
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.02
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: PACE Senior Care Partners |
$26.62
|
| Rate for Payer: PACE SWMI |
$28.02
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: PHP Medicare Advantage |
$28.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health HMO/PPO |
$97.53
|
| Rate for Payer: Priority Health Medicare |
$28.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.11
|
| Rate for Payer: Railroad Medicare Medicare |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.65
|
| Rate for Payer: UHC Core |
$93.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.02
|
| Rate for Payer: UHC Exchange |
$28.02
|
| Rate for Payer: UHC Medicare Advantage |
$28.02
|
| Rate for Payer: VA VA |
$28.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
OP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$556.67 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: Aetna Medicare |
$609.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$732.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$732.46
|
| Rate for Payer: BCBS Complete |
$937.55
|
| Rate for Payer: BCBS MAPPO |
$585.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.90
|
| Rate for Payer: BCN Commercial |
$1,822.37
|
| Rate for Payer: BCN Medicare Advantage |
$585.97
|
| Rate for Payer: Cash Price |
$1,875.10
|
| Rate for Payer: Cofinity Commercial |
$2,015.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,875.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.97
|
| Rate for Payer: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$673.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: Nomi Health Commercial |
$1,921.98
|
| Rate for Payer: PACE Senior Care Partners |
$556.67
|
| Rate for Payer: PACE SWMI |
$585.97
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| Rate for Payer: PHP Medicare Advantage |
$585.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,523.52
|
| Rate for Payer: Priority Health HMO/PPO |
$2,039.18
|
| Rate for Payer: Priority Health Medicare |
$591.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,570.40
|
| Rate for Payer: Railroad Medicare Medicare |
$585.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.61
|
| Rate for Payer: UHC Core |
$1,957.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$585.97
|
| Rate for Payer: UHC Exchange |
$585.97
|
| Rate for Payer: UHC Medicare Advantage |
$585.97
|
| Rate for Payer: VA VA |
$585.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
