|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.15
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: BCBS MAPPO |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$15.29
|
| Rate for Payer: BCN Medicare Advantage |
$4.92
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: PACE Senior Care Partners |
$4.67
|
| Rate for Payer: PACE SWMI |
$4.92
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health HMO/PPO |
$17.11
|
| Rate for Payer: Priority Health Medicare |
$4.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.31
|
| Rate for Payer: UHC Core |
$16.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.92
|
| Rate for Payer: UHC Exchange |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.92
|
| Rate for Payer: VA VA |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.75
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health HMO/PPO |
$17.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.31
|
| Rate for Payer: UHC Core |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.75
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCN Commercial |
$18.73
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: PACE Senior Care Partners |
$5.72
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.02
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCN Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$18.62
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$964.72 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.54
|
| Rate for Payer: BCN Commercial |
$1,146.98
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: Nomi Health Commercial |
$1,217.04
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,291.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.09
|
| Rate for Payer: UHC Core |
$1,239.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.14
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$222.05
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.33 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Aetna Commercial |
$188.74
|
| Rate for Payer: BCBS Trust/PPO |
$181.26
|
| Rate for Payer: BCN Commercial |
$171.60
|
| Rate for Payer: Cash Price |
$177.64
|
| Rate for Payer: Cofinity Commercial |
$190.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.64
|
| Rate for Payer: Healthscope Commercial |
$199.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.74
|
| Rate for Payer: Nomi Health Commercial |
$182.08
|
| Rate for Payer: PHP Commercial |
$188.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.33
|
| Rate for Payer: Priority Health HMO/PPO |
$193.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.40
|
| Rate for Payer: UHC Core |
$185.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna Medicare |
$385.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.81
|
| Rate for Payer: BCBS Complete |
$593.68
|
| Rate for Payer: BCBS MAPPO |
$371.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.15
|
| Rate for Payer: BCN Commercial |
$1,153.96
|
| Rate for Payer: BCN Medicare Advantage |
$371.05
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: Nomi Health Commercial |
$1,217.04
|
| Rate for Payer: PACE Senior Care Partners |
$352.50
|
| Rate for Payer: PACE SWMI |
$371.05
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: PHP Medicare Advantage |
$371.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,291.25
|
| Rate for Payer: Priority Health Medicare |
$374.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.41
|
| Rate for Payer: Railroad Medicare Medicare |
$371.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.09
|
| Rate for Payer: UHC Core |
$1,239.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.05
|
| Rate for Payer: UHC Exchange |
$371.05
|
| Rate for Payer: UHC Medicare Advantage |
$371.05
|
| Rate for Payer: VA VA |
$371.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.14
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$222.05
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Aetna Commercial |
$188.74
|
| Rate for Payer: Aetna Medicare |
$57.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.39
|
| Rate for Payer: BCBS Complete |
$88.82
|
| Rate for Payer: BCBS MAPPO |
$55.51
|
| Rate for Payer: BCBS Trust/PPO |
$182.55
|
| Rate for Payer: BCN Commercial |
$172.64
|
| Rate for Payer: BCN Medicare Advantage |
$55.51
|
| Rate for Payer: Cash Price |
$177.64
|
| Rate for Payer: Cofinity Commercial |
$190.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.51
|
| Rate for Payer: Healthscope Commercial |
$199.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.74
|
| Rate for Payer: Nomi Health Commercial |
$182.08
|
| Rate for Payer: PACE Senior Care Partners |
$52.74
|
| Rate for Payer: PACE SWMI |
$55.51
|
| Rate for Payer: PHP Commercial |
$188.74
|
| Rate for Payer: PHP Medicare Advantage |
$55.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.33
|
| Rate for Payer: Priority Health HMO/PPO |
$193.18
|
| Rate for Payer: Priority Health Medicare |
$56.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.77
|
| Rate for Payer: Railroad Medicare Medicare |
$55.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.40
|
| Rate for Payer: UHC Core |
$185.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.51
|
| Rate for Payer: UHC Exchange |
$55.51
|
| Rate for Payer: UHC Medicare Advantage |
$55.51
|
| Rate for Payer: VA VA |
$55.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$1,041.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,251.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,251.87
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS MAPPO |
$1,001.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,293.32
|
| Rate for Payer: BCN Commercial |
$3,114.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,001.50
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,001.50
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Mclaren Medicaid |
$8.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,051.57
|
| Rate for Payer: Meridian Medicaid |
$9.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$3,284.91
|
| Rate for Payer: PACE Senior Care Partners |
$951.42
|
| Rate for Payer: PACE SWMI |
$1,001.50
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,001.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3,485.21
|
| Rate for Payer: Priority Health Medicare |
$1,011.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,684.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,001.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,525.27
|
| Rate for Payer: UHC Core |
$3,345.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,001.50
|
| Rate for Payer: UHC Exchange |
$1,001.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,001.50
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: VA VA |
$1,001.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,603.89 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,270.09
|
| Rate for Payer: BCN Commercial |
$3,095.83
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$3,284.91
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3,485.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,684.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,525.27
|
| Rate for Payer: UHC Core |
$3,345.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$107.80
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.66
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.74 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: BCBS Trust/PPO |
$272.20
|
| Rate for Payer: BCN Commercial |
$257.69
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Nomi Health Commercial |
$273.43
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.74
|
| Rate for Payer: Priority Health HMO/PPO |
$290.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.44
|
| Rate for Payer: UHC Core |
$278.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.09
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.18
|
| Rate for Payer: BCN Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.19 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: Aetna Medicare |
$86.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.20
|
| Rate for Payer: BCBS Complete |
$133.38
|
| Rate for Payer: BCBS MAPPO |
$83.36
|
| Rate for Payer: BCBS Trust/PPO |
$274.13
|
| Rate for Payer: BCN Commercial |
$259.26
|
| Rate for Payer: BCN Medicare Advantage |
$83.36
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.36
|
| Rate for Payer: Healthscope Commercial |
$300.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Nomi Health Commercial |
$273.43
|
| Rate for Payer: PACE Senior Care Partners |
$79.19
|
| Rate for Payer: PACE SWMI |
$83.36
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: PHP Medicare Advantage |
$83.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.74
|
| Rate for Payer: Priority Health HMO/PPO |
$290.10
|
| Rate for Payer: Priority Health Medicare |
$84.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.41
|
| Rate for Payer: Railroad Medicare Medicare |
$83.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.44
|
| Rate for Payer: UHC Core |
$278.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.36
|
| Rate for Payer: UHC Exchange |
$83.36
|
| Rate for Payer: UHC Medicare Advantage |
$83.36
|
| Rate for Payer: VA VA |
$83.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.09
|
|
|
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
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$324.05 |
| 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 |
$324.05
|
| 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 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
|
$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
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 43547027010
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.73 |
| Max. Negotiated Rate |
$171.31 |
| 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 |
$171.31
|
| 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
|
$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 |
$101.75
|
| 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
|
IP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.03 |
| Max. Negotiated Rate |
$324.05 |
| 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 |
$324.05
|
| 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
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 43547027010
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$171.31 |
| 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 |
$171.31
|
| 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
|
|
