|
RISEDRONATE 35 MG TABLET
|
Facility
|
OP
|
$3,526.70
|
|
|
Service Code
|
NDC 00430047207
|
| Hospital Charge Code |
32895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,304.88 |
| Max. Negotiated Rate |
$3,174.03 |
| Rate for Payer: Aetna American Axle |
$2,292.36
|
| Rate for Payer: Aetna Commercial |
$2,997.70
|
| Rate for Payer: Aetna Medicare |
$1,763.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.36
|
| Rate for Payer: BCBS Complete |
$1,410.68
|
| Rate for Payer: Cash Price |
$2,821.36
|
| Rate for Payer: Cofinity Advantage |
$2,468.69
|
| Rate for Payer: Cofinity Commercial |
$3,032.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.36
|
| Rate for Payer: Healthscope Commercial |
$3,174.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,468.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,821.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.03
|
| Rate for Payer: PHP Commercial |
$2,997.70
|
| Rate for Payer: Priority Health SBD |
$2,221.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,292.36
|
| Rate for Payer: UHC Core |
$1,837.41
|
| Rate for Payer: UHC Exchange |
$1,385.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,304.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.03
|
|
|
RISEDRONATE 5 MG TABLET
|
Facility
|
IP
|
$262.74
|
|
|
Service Code
|
NDC 33342010707
|
| Hospital Charge Code |
27112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$236.47 |
| Rate for Payer: Aetna American Axle |
$170.78
|
| Rate for Payer: Aetna Commercial |
$223.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.78
|
| Rate for Payer: Cash Price |
$210.19
|
| Rate for Payer: Cofinity Advantage |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$225.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.19
|
| Rate for Payer: Healthscope Commercial |
$236.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.06
|
| Rate for Payer: PHP Commercial |
$223.33
|
| Rate for Payer: Priority Health SBD |
$165.53
|
| Rate for Payer: UMR Bronson Commercial |
$115.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.06
|
|
|
RISEDRONATE 5 MG TABLET
|
Facility
|
OP
|
$262.74
|
|
|
Service Code
|
NDC 33342010707
|
| Hospital Charge Code |
27112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.21 |
| Max. Negotiated Rate |
$236.47 |
| Rate for Payer: Aetna American Axle |
$170.78
|
| Rate for Payer: Aetna Commercial |
$223.33
|
| Rate for Payer: Aetna Medicare |
$131.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.78
|
| Rate for Payer: BCBS Complete |
$105.10
|
| Rate for Payer: Cash Price |
$210.19
|
| Rate for Payer: Cofinity Advantage |
$183.92
|
| Rate for Payer: Cofinity Commercial |
$225.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.19
|
| Rate for Payer: Healthscope Commercial |
$236.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.06
|
| Rate for Payer: PHP Commercial |
$223.33
|
| Rate for Payer: Priority Health SBD |
$165.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.78
|
| Rate for Payer: UHC Core |
$136.89
|
| Rate for Payer: UHC Exchange |
$103.26
|
| Rate for Payer: UMR Bronson Commercial |
$97.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.06
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$413.60
|
|
|
Service Code
|
NDC 00904736061
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.98 |
| Max. Negotiated Rate |
$372.24 |
| Rate for Payer: Aetna American Axle |
$268.84
|
| Rate for Payer: Aetna Commercial |
$351.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.84
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cofinity Advantage |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$355.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.88
|
| Rate for Payer: Healthscope Commercial |
$372.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.20
|
| Rate for Payer: PHP Commercial |
$351.56
|
| Rate for Payer: Priority Health SBD |
$260.57
|
| Rate for Payer: UMR Bronson Commercial |
$181.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.20
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$413.60
|
|
|
Service Code
|
NDC 00904736061
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$372.24 |
| Rate for Payer: Aetna American Axle |
$268.84
|
| Rate for Payer: Aetna Commercial |
$351.56
|
| Rate for Payer: Aetna Medicare |
$206.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.84
|
| Rate for Payer: BCBS Complete |
$165.44
|
| Rate for Payer: Cash Price |
$330.88
|
| Rate for Payer: Cofinity Advantage |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$355.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.88
|
| Rate for Payer: Healthscope Commercial |
$372.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$310.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$310.20
|
| Rate for Payer: PHP Commercial |
$351.56
|
| Rate for Payer: Priority Health SBD |
$260.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$215.49
|
| Rate for Payer: UHC Exchange |
$162.54
|
| Rate for Payer: UMR Bronson Commercial |
$153.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$310.20
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna American Axle |
$27.50
|
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.50
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Advantage |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.73
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health SBD |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.73
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$42.30
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna American Axle |
$27.50
|
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$21.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.50
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Advantage |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.73
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health SBD |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.50
|
| Rate for Payer: UHC Core |
$22.04
|
| Rate for Payer: UHC Exchange |
$16.62
|
| Rate for Payer: UMR Bronson Commercial |
$15.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.73
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$46.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: BCBS Complete |
$37.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Advantage |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.31
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.94
|
| Rate for Payer: UHC Core |
$48.84
|
| Rate for Payer: UHC Exchange |
$36.84
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.04 |
| Max. Negotiated Rate |
$377.13 |
| Rate for Payer: Aetna American Axle |
$272.37
|
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna Medicare |
$209.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.37
|
| Rate for Payer: BCBS Complete |
$167.61
|
| Rate for Payer: Cash Price |
$335.22
|
| Rate for Payer: Cofinity Advantage |
$293.32
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.22
|
| Rate for Payer: Healthscope Commercial |
$377.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$335.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.27
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health SBD |
$263.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.37
|
| Rate for Payer: UHC Core |
$218.31
|
| Rate for Payer: UHC Exchange |
$164.68
|
| Rate for Payer: UMR Bronson Commercial |
$155.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.27
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$565.22
|
|
|
Service Code
|
NDC 50458030503
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna American Axle |
$367.39
|
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.39
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Advantage |
$395.65
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.92
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: Priority Health SBD |
$356.09
|
| Rate for Payer: UMR Bronson Commercial |
$248.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Advantage |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.31
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$41.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$565.22
|
|
|
Service Code
|
NDC 50458030503
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.13 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna American Axle |
$367.39
|
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: Aetna Medicare |
$282.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.39
|
| Rate for Payer: BCBS Complete |
$226.09
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Advantage |
$395.65
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.92
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: Priority Health SBD |
$356.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.39
|
| Rate for Payer: UHC Core |
$294.48
|
| Rate for Payer: UHC Exchange |
$222.13
|
| Rate for Payer: UMR Bronson Commercial |
$209.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.37 |
| Max. Negotiated Rate |
$377.13 |
| Rate for Payer: Aetna American Axle |
$272.37
|
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.37
|
| Rate for Payer: Cash Price |
$335.22
|
| Rate for Payer: Cofinity Advantage |
$293.32
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.22
|
| Rate for Payer: Healthscope Commercial |
$377.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.27
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health SBD |
$263.99
|
| Rate for Payer: UMR Bronson Commercial |
$184.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.27
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$53.58
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna American Axle |
$34.83
|
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna Medicare |
$26.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: BCBS Complete |
$21.43
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Advantage |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health SBD |
$33.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.83
|
| Rate for Payer: UHC Core |
$27.92
|
| Rate for Payer: UHC Exchange |
$21.06
|
| Rate for Payer: UMR Bronson Commercial |
$19.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.19
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.96
|
| Rate for Payer: UHC Core |
$176.31
|
| Rate for Payer: UHC Exchange |
$132.99
|
| Rate for Payer: UMR Bronson Commercial |
$125.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$3.01
|
|
|
Service Code
|
NDC 68084027211
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.56
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.57
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Advantage |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.80
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$197.40
|
|
|
Service Code
|
NDC 27241000106
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna Medicare |
$98.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: BCBS Complete |
$78.96
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Advantage |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.31
|
| Rate for Payer: UHC Core |
$102.85
|
| Rate for Payer: UHC Exchange |
$77.58
|
| Rate for Payer: UMR Bronson Commercial |
$73.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.07 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$150.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: BCBS Complete |
$120.08
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Advantage |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.15
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.13
|
| Rate for Payer: UHC Core |
$156.40
|
| Rate for Payer: UHC Exchange |
$117.98
|
| Rate for Payer: UMR Bronson Commercial |
$111.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$197.40
|
|
|
Service Code
|
NDC 27241000106
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.86 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna American Axle |
$128.31
|
| Rate for Payer: Aetna Commercial |
$167.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.31
|
| Rate for Payer: Cash Price |
$157.92
|
| Rate for Payer: Cofinity Advantage |
$138.18
|
| Rate for Payer: Cofinity Commercial |
$169.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.92
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.05
|
| Rate for Payer: PHP Commercial |
$167.79
|
| Rate for Payer: Priority Health SBD |
$124.36
|
| Rate for Payer: UMR Bronson Commercial |
$86.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.05
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna American Axle |
$34.83
|
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Advantage |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health SBD |
$33.76
|
| Rate for Payer: UMR Bronson Commercial |
$23.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.19
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Advantage |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.15
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$3.01
|
|
|
Service Code
|
NDC 68084027211
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.71 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$2.41
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$2.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.56
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.26
|
|
