|
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 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 |
$200.21 |
| 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 |
$200.21
|
| 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 |
$200.21 |
| 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 |
$200.21
|
| 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 |
$72.73
|
| 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 |
$72.73
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$72.73
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$24.25
|
| 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 |
$72.73
|
| 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
|
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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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 |
$7.21
|
| 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
|
|
|
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
|
|
|
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
|
$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
|
$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
|
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 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 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
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,523.52 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,913.31
|
| Rate for Payer: BCN Commercial |
$1,811.35
|
| 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: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: Nomi Health Commercial |
$1,921.98
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| 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 Narrow/Tiered Network |
$1,570.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.61
|
| Rate for Payer: UHC Core |
$1,957.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
OP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
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
|
|
|
SACUBITRIL 49 MG-VALSARTAN 51 MG TABLET
|
Facility
|
IP
|
$2,343.88
|
|
|
Service Code
|
NDC 00078077720
|
| Hospital Charge Code |
174640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,523.52 |
| Max. Negotiated Rate |
$2,109.49 |
| Rate for Payer: Aetna Commercial |
$1,992.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,913.31
|
| Rate for Payer: BCN Commercial |
$1,811.35
|
| 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: Healthscope Commercial |
$2,109.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,757.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,992.30
|
| Rate for Payer: Nomi Health Commercial |
$1,921.98
|
| Rate for Payer: PHP Commercial |
$1,992.30
|
| 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 Narrow/Tiered Network |
$1,570.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.61
|
| Rate for Payer: UHC Core |
$1,957.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,757.91
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
IP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.23 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$19.30
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SALIVA STIMULANT COMBINATION NO.3 ORAL MUCOSAL SPRAY
|
Facility
|
OP
|
$24.97
|
|
|
Service Code
|
NDC 48582000155
|
| Hospital Charge Code |
118454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna Commercial |
$21.22
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.80
|
| Rate for Payer: BCBS Complete |
$9.99
|
| Rate for Payer: BCBS MAPPO |
$6.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.53
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.24
|
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$22.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.22
|
| Rate for Payer: Nomi Health Commercial |
$20.48
|
| Rate for Payer: PACE Senior Care Partners |
$5.93
|
| Rate for Payer: PACE SWMI |
$6.24
|
| Rate for Payer: PHP Commercial |
$21.22
|
| Rate for Payer: PHP Medicare Advantage |
$6.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.23
|
| Rate for Payer: Priority Health HMO/PPO |
$21.72
|
| Rate for Payer: Priority Health Medicare |
$6.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.73
|
| Rate for Payer: Railroad Medicare Medicare |
$6.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.97
|
| Rate for Payer: UHC Core |
$20.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.24
|
| Rate for Payer: UHC Exchange |
$6.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.24
|
| Rate for Payer: VA VA |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.73
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$63.25
|
|
|
Service Code
|
NDC 00378647016
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$56.92 |
| Rate for Payer: Aetna Commercial |
$53.76
|
| Rate for Payer: BCBS Trust/PPO |
$51.63
|
| Rate for Payer: BCN Commercial |
$48.88
|
| Rate for Payer: Cash Price |
$50.60
|
| Rate for Payer: Cofinity Commercial |
$54.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.60
|
| Rate for Payer: Healthscope Commercial |
$56.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.76
|
| Rate for Payer: Nomi Health Commercial |
$51.87
|
| Rate for Payer: PHP Commercial |
$53.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.11
|
| Rate for Payer: Priority Health HMO/PPO |
$55.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.66
|
| Rate for Payer: UHC Core |
$52.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.44
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$245.35
|
|
|
Service Code
|
NDC 50742050510
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$220.81 |
| Rate for Payer: Aetna Commercial |
$208.55
|
| Rate for Payer: Aetna Medicare |
$63.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.67
|
| Rate for Payer: BCBS Complete |
$98.14
|
| Rate for Payer: BCBS MAPPO |
$61.34
|
| Rate for Payer: BCBS Trust/PPO |
$201.70
|
| Rate for Payer: BCN Commercial |
$190.76
|
| Rate for Payer: BCN Medicare Advantage |
$61.34
|
| Rate for Payer: Cash Price |
$196.28
|
| Rate for Payer: Cofinity Commercial |
$211.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.34
|
| Rate for Payer: Healthscope Commercial |
$220.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.55
|
| Rate for Payer: Nomi Health Commercial |
$201.19
|
| Rate for Payer: PACE Senior Care Partners |
$58.27
|
| Rate for Payer: PACE SWMI |
$61.34
|
| Rate for Payer: PHP Commercial |
$208.55
|
| Rate for Payer: PHP Medicare Advantage |
$61.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.48
|
| Rate for Payer: Priority Health HMO/PPO |
$213.45
|
| Rate for Payer: Priority Health Medicare |
$61.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.38
|
| Rate for Payer: Railroad Medicare Medicare |
$61.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.91
|
| Rate for Payer: UHC Core |
$204.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.34
|
| Rate for Payer: UHC Exchange |
$61.34
|
| Rate for Payer: UHC Medicare Advantage |
$61.34
|
| Rate for Payer: VA VA |
$61.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.01
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
OP
|
$24.23
|
|
|
Service Code
|
NDC 50742050501
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.75 |
| Max. Negotiated Rate |
$21.81 |
| Rate for Payer: Aetna Commercial |
$20.60
|
| Rate for Payer: Aetna Medicare |
$6.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.57
|
| Rate for Payer: BCBS Complete |
$9.69
|
| Rate for Payer: BCBS MAPPO |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$18.84
|
| Rate for Payer: BCN Medicare Advantage |
$6.06
|
| Rate for Payer: Cash Price |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$20.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$21.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.60
|
| Rate for Payer: Nomi Health Commercial |
$19.87
|
| Rate for Payer: PACE Senior Care Partners |
$5.75
|
| Rate for Payer: PACE SWMI |
$6.06
|
| Rate for Payer: PHP Commercial |
$20.60
|
| Rate for Payer: PHP Medicare Advantage |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.75
|
| Rate for Payer: Priority Health HMO/PPO |
$21.08
|
| Rate for Payer: Priority Health Medicare |
$6.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.32
|
| Rate for Payer: UHC Core |
$20.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.06
|
| Rate for Payer: UHC Exchange |
$6.06
|
| Rate for Payer: UHC Medicare Advantage |
$6.06
|
| Rate for Payer: VA VA |
$6.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.17
|
|
|
SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH
|
Facility
|
IP
|
$586.71
|
|
|
Service Code
|
NDC 50742050524
|
| Hospital Charge Code |
27696
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.36 |
| Max. Negotiated Rate |
$528.04 |
| Rate for Payer: Aetna Commercial |
$498.70
|
| Rate for Payer: BCBS Trust/PPO |
$478.93
|
| Rate for Payer: BCN Commercial |
$453.41
|
| Rate for Payer: Cash Price |
$469.37
|
| Rate for Payer: Cofinity Commercial |
$504.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$469.37
|
| Rate for Payer: Healthscope Commercial |
$528.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.70
|
| Rate for Payer: Nomi Health Commercial |
$481.10
|
| Rate for Payer: PHP Commercial |
$498.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$381.36
|
| Rate for Payer: Priority Health HMO/PPO |
$510.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$393.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.30
|
| Rate for Payer: UHC Core |
$489.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.03
|
|
