|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$3,894.98
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$3,505.48 |
| Rate for Payer: Aetna American Axle |
$2,531.74
|
| Rate for Payer: Aetna Commercial |
$3,310.73
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,531.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.41
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: BCBS MAPPO |
$10.73
|
| Rate for Payer: BCBS Trust/PPO |
$34.63
|
| Rate for Payer: BCN Medicare Advantage |
$10.73
|
| Rate for Payer: Cash Price |
$3,115.98
|
| Rate for Payer: Cash Price |
$3,115.98
|
| Rate for Payer: Cofinity Commercial |
$3,349.68
|
| Rate for Payer: Cofinity Commercial |
$2,726.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.73
|
| Rate for Payer: Healthscope Commercial |
$3,505.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,726.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,921.24
|
| Rate for Payer: Mclaren Medicaid |
$5.87
|
| Rate for Payer: Mclaren Medicare |
$10.73
|
| Rate for Payer: Meridian Medicaid |
$6.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,310.73
|
| Rate for Payer: PACE Medicare |
$10.19
|
| Rate for Payer: PACE SWMI |
$10.73
|
| Rate for Payer: PHP Commercial |
$3,310.73
|
| Rate for Payer: PHP Medicare Advantage |
$10.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,726.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.38
|
| Rate for Payer: Priority Health Medicare |
$10.73
|
| Rate for Payer: Priority Health Narrow Network |
$24.30
|
| Rate for Payer: Priority Health SBD |
$2,453.84
|
| Rate for Payer: Railroad Medicare Medicare |
$10.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.73
|
| Rate for Payer: UHC Medicare Advantage |
$11.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.14
|
| Rate for Payer: VA VA |
$10.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,921.24
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$3,894.98
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,713.79 |
| Max. Negotiated Rate |
$3,505.48 |
| Rate for Payer: Aetna American Axle |
$2,531.74
|
| Rate for Payer: Aetna Commercial |
$3,310.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,531.74
|
| Rate for Payer: Cash Price |
$3,115.98
|
| Rate for Payer: Cofinity Commercial |
$2,726.49
|
| Rate for Payer: Cofinity Commercial |
$3,349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.98
|
| Rate for Payer: Healthscope Commercial |
$3,505.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,726.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,921.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,310.73
|
| Rate for Payer: PHP Commercial |
$3,310.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,726.49
|
| Rate for Payer: Priority Health SBD |
$2,453.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,713.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,921.24
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 43547-268-10
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$339.15
|
|
|
Service Code
|
NDC 60687-577-01
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.23 |
| Max. Negotiated Rate |
$305.24 |
| Rate for Payer: Aetna American Axle |
$220.45
|
| Rate for Payer: Aetna Commercial |
$288.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.45
|
| Rate for Payer: Cash Price |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$237.40
|
| Rate for Payer: Cofinity Commercial |
$291.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.32
|
| Rate for Payer: Healthscope Commercial |
$305.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$288.28
|
| Rate for Payer: PHP Commercial |
$288.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.40
|
| Rate for Payer: Priority Health SBD |
$213.66
|
| Rate for Payer: UMR Bronson Commercial |
$149.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.36
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 68462-253-01
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.14
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 60687-577-11
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.06 |
| Rate for Payer: Aetna American Axle |
$2.21
|
| Rate for Payer: Aetna Commercial |
$2.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.21
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cofinity Commercial |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$3.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.89
|
| Rate for Payer: PHP Commercial |
$2.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.38
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.55
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 43547-270-10
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 16729-234-01
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 62332-032-31
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.54
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 0904-5996-01
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$290.70
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.40
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$150.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
ROPIVACAINE 0.2 % FOR NERVE BLOCK INJECTION
|
Facility
|
IP
|
$122.04
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
161560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$109.84 |
| Rate for Payer: Aetna American Axle |
$79.33
|
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Cofinity Commercial |
$85.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.73
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.43
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: UMR Bronson Commercial |
$53.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.53
|
|
|
ROPIVACAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$143.20
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18194
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.01 |
| Max. Negotiated Rate |
$128.88 |
| Rate for Payer: Aetna American Axle |
$93.08
|
| Rate for Payer: Aetna American Axle |
$26.44
|
| Rate for Payer: Aetna American Axle |
$48.10
|
| Rate for Payer: Aetna American Axle |
$47.69
|
| Rate for Payer: Aetna American Axle |
$48.82
|
| Rate for Payer: Aetna American Axle |
$52.67
|
| Rate for Payer: Aetna American Axle |
$64.69
|
| Rate for Payer: Aetna Commercial |
$34.58
|
| Rate for Payer: Aetna Commercial |
$62.36
|
| Rate for Payer: Aetna Commercial |
$121.72
|
| Rate for Payer: Aetna Commercial |
$68.88
|
| Rate for Payer: Aetna Commercial |
$63.84
|
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.08
|
| Rate for Payer: Cash Price |
$114.56
|
| Rate for Payer: Cash Price |
$58.70
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cash Price |
$64.82
|
| Rate for Payer: Cash Price |
$79.62
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$60.08
|
| Rate for Payer: Cofinity Commercial |
$63.10
|
| Rate for Payer: Cofinity Commercial |
$100.24
|
| Rate for Payer: Cofinity Commercial |
$123.15
|
| Rate for Payer: Cofinity Commercial |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$34.98
|
| Rate for Payer: Cofinity Commercial |
$51.36
|
| Rate for Payer: Cofinity Commercial |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$63.64
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$52.57
|
| Rate for Payer: Cofinity Commercial |
$64.59
|
| Rate for Payer: Cofinity Commercial |
$69.67
|
| Rate for Payer: Cofinity Commercial |
$56.72
|
| Rate for Payer: Cofinity Commercial |
$69.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.08
|
| Rate for Payer: Healthscope Commercial |
$36.61
|
| Rate for Payer: Healthscope Commercial |
$72.93
|
| Rate for Payer: Healthscope Commercial |
$66.03
|
| Rate for Payer: Healthscope Commercial |
$67.59
|
| Rate for Payer: Healthscope Commercial |
$66.60
|
| Rate for Payer: Healthscope Commercial |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$128.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.90
|
| Rate for Payer: PHP Commercial |
$62.36
|
| Rate for Payer: PHP Commercial |
$62.90
|
| Rate for Payer: PHP Commercial |
$34.58
|
| Rate for Payer: PHP Commercial |
$84.60
|
| Rate for Payer: PHP Commercial |
$121.72
|
| Rate for Payer: PHP Commercial |
$68.88
|
| Rate for Payer: PHP Commercial |
$63.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.24
|
| Rate for Payer: Priority Health SBD |
$25.63
|
| Rate for Payer: Priority Health SBD |
$90.22
|
| Rate for Payer: Priority Health SBD |
$46.22
|
| Rate for Payer: Priority Health SBD |
$46.62
|
| Rate for Payer: Priority Health SBD |
$47.31
|
| Rate for Payer: Priority Health SBD |
$51.05
|
| Rate for Payer: Priority Health SBD |
$62.70
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: UMR Bronson Commercial |
$32.56
|
| Rate for Payer: UMR Bronson Commercial |
$32.28
|
| Rate for Payer: UMR Bronson Commercial |
$17.90
|
| Rate for Payer: UMR Bronson Commercial |
$63.01
|
| Rate for Payer: UMR Bronson Commercial |
$43.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.77
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$169.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
169800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.73 |
| Max. Negotiated Rate |
$152.85 |
| Rate for Payer: Aetna American Axle |
$110.39
|
| Rate for Payer: Aetna Commercial |
$144.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.39
|
| Rate for Payer: Cash Price |
$135.86
|
| Rate for Payer: Cofinity Commercial |
$118.88
|
| Rate for Payer: Cofinity Commercial |
$146.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.86
|
| Rate for Payer: Healthscope Commercial |
$152.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.36
|
| Rate for Payer: PHP Commercial |
$144.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.88
|
| Rate for Payer: Priority Health SBD |
$106.99
|
| Rate for Payer: UMR Bronson Commercial |
$74.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.37
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$163.33
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.87 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna American Axle |
$106.16
|
| Rate for Payer: Aetna American Axle |
$99.60
|
| Rate for Payer: Aetna American Axle |
$79.33
|
| Rate for Payer: Aetna American Axle |
$110.39
|
| Rate for Payer: Aetna American Axle |
$197.85
|
| Rate for Payer: Aetna American Axle |
$116.42
|
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Commercial |
$258.73
|
| Rate for Payer: Aetna Commercial |
$144.36
|
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Commercial |
$152.24
|
| Rate for Payer: Aetna Commercial |
$138.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.60
|
| Rate for Payer: Cash Price |
$97.63
|
| Rate for Payer: Cash Price |
$122.58
|
| Rate for Payer: Cash Price |
$143.29
|
| Rate for Payer: Cash Price |
$130.66
|
| Rate for Payer: Cash Price |
$243.51
|
| Rate for Payer: Cash Price |
$135.86
|
| Rate for Payer: Cofinity Commercial |
$154.03
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Cofinity Commercial |
$85.43
|
| Rate for Payer: Cofinity Commercial |
$107.26
|
| Rate for Payer: Cofinity Commercial |
$131.78
|
| Rate for Payer: Cofinity Commercial |
$114.33
|
| Rate for Payer: Cofinity Commercial |
$140.46
|
| Rate for Payer: Cofinity Commercial |
$118.88
|
| Rate for Payer: Cofinity Commercial |
$146.05
|
| Rate for Payer: Cofinity Commercial |
$125.38
|
| Rate for Payer: Cofinity Commercial |
$213.07
|
| Rate for Payer: Cofinity Commercial |
$261.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.29
|
| Rate for Payer: Healthscope Commercial |
$109.84
|
| Rate for Payer: Healthscope Commercial |
$147.00
|
| Rate for Payer: Healthscope Commercial |
$137.91
|
| Rate for Payer: Healthscope Commercial |
$161.20
|
| Rate for Payer: Healthscope Commercial |
$273.95
|
| Rate for Payer: Healthscope Commercial |
$152.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$107.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$258.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$152.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.25
|
| Rate for Payer: PHP Commercial |
$258.73
|
| Rate for Payer: PHP Commercial |
$144.36
|
| Rate for Payer: PHP Commercial |
$130.25
|
| Rate for Payer: PHP Commercial |
$138.83
|
| Rate for Payer: PHP Commercial |
$152.24
|
| Rate for Payer: PHP Commercial |
$103.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.88
|
| Rate for Payer: Priority Health SBD |
$106.99
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: Priority Health SBD |
$102.90
|
| Rate for Payer: Priority Health SBD |
$112.84
|
| Rate for Payer: Priority Health SBD |
$191.77
|
| Rate for Payer: Priority Health SBD |
$96.53
|
| Rate for Payer: UMR Bronson Commercial |
$67.42
|
| Rate for Payer: UMR Bronson Commercial |
$133.93
|
| Rate for Payer: UMR Bronson Commercial |
$74.73
|
| Rate for Payer: UMR Bronson Commercial |
$78.81
|
| Rate for Payer: UMR Bronson Commercial |
$71.87
|
| Rate for Payer: UMR Bronson Commercial |
$53.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.29
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) PAIN PUMP (BMH)
|
Facility
|
IP
|
$688.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
154973
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.09 |
| Max. Negotiated Rate |
$619.95 |
| Rate for Payer: Aetna American Axle |
$447.74
|
| Rate for Payer: Aetna American Axle |
$542.22
|
| Rate for Payer: Aetna Commercial |
$709.05
|
| Rate for Payer: Aetna Commercial |
$585.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.22
|
| Rate for Payer: Cash Price |
$551.06
|
| Rate for Payer: Cash Price |
$667.34
|
| Rate for Payer: Cofinity Commercial |
$583.93
|
| Rate for Payer: Cofinity Commercial |
$482.18
|
| Rate for Payer: Cofinity Commercial |
$592.39
|
| Rate for Payer: Cofinity Commercial |
$717.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$667.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$551.06
|
| Rate for Payer: Healthscope Commercial |
$619.95
|
| Rate for Payer: Healthscope Commercial |
$750.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$482.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$625.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$516.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$585.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$709.05
|
| Rate for Payer: PHP Commercial |
$585.51
|
| Rate for Payer: PHP Commercial |
$709.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.18
|
| Rate for Payer: Priority Health SBD |
$433.96
|
| Rate for Payer: Priority Health SBD |
$525.53
|
| Rate for Payer: UMR Bronson Commercial |
$303.09
|
| Rate for Payer: UMR Bronson Commercial |
$367.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$516.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$625.64
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$15.89
|
| Rate for Payer: Aetna American Axle |
$19.05
|
| Rate for Payer: Aetna American Axle |
$18.49
|
| Rate for Payer: Aetna American Axle |
$21.87
|
| Rate for Payer: Aetna American Axle |
$13.62
|
| Rate for Payer: Aetna American Axle |
$13.36
|
| Rate for Payer: Aetna American Axle |
$52.59
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$28.60
|
| Rate for Payer: Aetna Commercial |
$68.77
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$24.91
|
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.36
|
| Rate for Payer: Cash Price |
$64.73
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cash Price |
$26.92
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$69.58
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$23.56
|
| Rate for Payer: Cofinity Commercial |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$56.64
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$30.28
|
| Rate for Payer: Healthscope Commercial |
$72.82
|
| Rate for Payer: Healthscope Commercial |
$26.38
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.42
|
| 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 |
$25.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.60
|
| Rate for Payer: PHP Commercial |
$28.60
|
| Rate for Payer: PHP Commercial |
$68.77
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Commercial |
$24.91
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| Rate for Payer: Priority Health SBD |
$18.47
|
| Rate for Payer: Priority Health SBD |
$21.20
|
| Rate for Payer: Priority Health SBD |
$13.20
|
| Rate for Payer: Priority Health SBD |
$17.92
|
| Rate for Payer: Priority Health SBD |
$12.95
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: Priority Health SBD |
$50.97
|
| Rate for Payer: Priority Health SBD |
$15.40
|
| Rate for Payer: UMR Bronson Commercial |
$12.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.22
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: UMR Bronson Commercial |
$14.81
|
| Rate for Payer: UMR Bronson Commercial |
$35.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$9.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.68
|
|
|
ROPIVACAINE (PF) 7.5 MG/ML (0.75 %) INJECTION SOLUTION
|
Facility
|
IP
|
$20.65
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$481.92
|
|
|
Service Code
|
NDC 0904-6779-61
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.04 |
| Max. Negotiated Rate |
$433.73 |
| Rate for Payer: Aetna American Axle |
$313.25
|
| Rate for Payer: Aetna Commercial |
$409.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.25
|
| Rate for Payer: Cash Price |
$385.54
|
| Rate for Payer: Cofinity Commercial |
$414.45
|
| Rate for Payer: Cofinity Commercial |
$337.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.54
|
| Rate for Payer: Healthscope Commercial |
$433.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.63
|
| Rate for Payer: PHP Commercial |
$409.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.34
|
| Rate for Payer: Priority Health SBD |
$303.61
|
| Rate for Payer: UMR Bronson Commercial |
$212.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.44
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 13668-180-90
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.50
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
ROSUVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$372.24
|
|
|
Service Code
|
NDC 31722-883-90
|
| Hospital Charge Code |
35134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.79 |
| Max. Negotiated Rate |
$335.02 |
| Rate for Payer: Aetna American Axle |
$241.96
|
| Rate for Payer: Aetna Commercial |
$316.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.96
|
| Rate for Payer: Cash Price |
$297.79
|
| Rate for Payer: Cofinity Commercial |
$260.57
|
| Rate for Payer: Cofinity Commercial |
$320.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.79
|
| Rate for Payer: Healthscope Commercial |
$335.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.40
|
| Rate for Payer: PHP Commercial |
$316.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.57
|
| Rate for Payer: Priority Health SBD |
$234.51
|
| Rate for Payer: UMR Bronson Commercial |
$163.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.18
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$440.16
|
|
|
Service Code
|
NDC 0904-6780-61
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.67 |
| Max. Negotiated Rate |
$396.14 |
| Rate for Payer: Aetna American Axle |
$286.10
|
| Rate for Payer: Aetna Commercial |
$374.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.10
|
| Rate for Payer: Cash Price |
$352.13
|
| Rate for Payer: Cofinity Commercial |
$308.11
|
| Rate for Payer: Cofinity Commercial |
$378.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.13
|
| Rate for Payer: Healthscope Commercial |
$396.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.14
|
| Rate for Payer: PHP Commercial |
$374.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.11
|
| Rate for Payer: Priority Health SBD |
$277.30
|
| Rate for Payer: UMR Bronson Commercial |
$193.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.12
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$232.65
|
|
|
Service Code
|
NDC 68462-263-90
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.37 |
| Max. Negotiated Rate |
$209.38 |
| Rate for Payer: Aetna American Axle |
$151.22
|
| Rate for Payer: Aetna Commercial |
$197.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.22
|
| Rate for Payer: Cash Price |
$186.12
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Cofinity Commercial |
$200.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.12
|
| Rate for Payer: Healthscope Commercial |
$209.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.75
|
| Rate for Payer: PHP Commercial |
$197.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.86
|
| Rate for Payer: Priority Health SBD |
$146.57
|
| Rate for Payer: UMR Bronson Commercial |
$102.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.49
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$372.24
|
|
|
Service Code
|
NDC 31722-884-90
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.79 |
| Max. Negotiated Rate |
$335.02 |
| Rate for Payer: Aetna American Axle |
$241.96
|
| Rate for Payer: Aetna Commercial |
$316.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.96
|
| Rate for Payer: Cash Price |
$297.79
|
| Rate for Payer: Cofinity Commercial |
$260.57
|
| Rate for Payer: Cofinity Commercial |
$320.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.79
|
| Rate for Payer: Healthscope Commercial |
$335.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.40
|
| Rate for Payer: PHP Commercial |
$316.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.57
|
| Rate for Payer: Priority Health SBD |
$234.51
|
| Rate for Payer: UMR Bronson Commercial |
$163.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.18
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$2,862.47
|
|
|
Service Code
|
NDC 0310-0752-90
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,259.49 |
| Max. Negotiated Rate |
$2,576.22 |
| Rate for Payer: Aetna American Axle |
$1,860.61
|
| Rate for Payer: Aetna Commercial |
$2,433.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,860.61
|
| Rate for Payer: Cash Price |
$2,289.98
|
| Rate for Payer: Cofinity Commercial |
$2,003.73
|
| Rate for Payer: Cofinity Commercial |
$2,461.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,289.98
|
| Rate for Payer: Healthscope Commercial |
$2,576.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,003.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,146.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,433.10
|
| Rate for Payer: PHP Commercial |
$2,433.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.73
|
| Rate for Payer: Priority Health SBD |
$1,803.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,146.85
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$224.19
|
|
|
Service Code
|
NDC 27808-157-01
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$201.77 |
| Rate for Payer: Aetna American Axle |
$145.72
|
| Rate for Payer: Aetna Commercial |
$190.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.72
|
| Rate for Payer: Cash Price |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$156.93
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.35
|
| Rate for Payer: Healthscope Commercial |
$201.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.56
|
| Rate for Payer: PHP Commercial |
$190.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.93
|
| Rate for Payer: Priority Health SBD |
$141.24
|
| Rate for Payer: UMR Bronson Commercial |
$98.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.14
|
|
