|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$111.72
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$100.55 |
| Rate for Payer: Aetna American Axle |
$72.62
|
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.62
|
| Rate for Payer: Cash Price |
$89.38
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.38
|
| Rate for Payer: Healthscope Commercial |
$100.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.96
|
| Rate for Payer: PHP Commercial |
$94.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.62
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$49.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.79
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$310.65
|
|
|
Service Code
|
NDC 69097082507
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Commercial |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.92
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UMR Bronson Commercial |
$136.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$111.72
|
|
|
Service Code
|
NDC 69097082502
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$100.55 |
| Rate for Payer: Aetna American Axle |
$72.62
|
| Rate for Payer: Aetna Commercial |
$94.96
|
| Rate for Payer: Aetna Medicare |
$55.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.62
|
| Rate for Payer: BCBS Complete |
$44.69
|
| Rate for Payer: Cash Price |
$89.38
|
| Rate for Payer: Cofinity Commercial |
$78.20
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.38
|
| Rate for Payer: Healthscope Commercial |
$100.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.96
|
| Rate for Payer: PHP Commercial |
$94.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.62
|
| Rate for Payer: Priority Health SBD |
$70.38
|
| Rate for Payer: UMR Bronson Commercial |
$41.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.79
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.33 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.63
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UMR Bronson Commercial |
$38.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$87.12
|
|
|
Service Code
|
NDC 65162005703
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$78.41 |
| Rate for Payer: Aetna American Axle |
$56.63
|
| Rate for Payer: Aetna Commercial |
$74.05
|
| Rate for Payer: Aetna Medicare |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$34.85
|
| Rate for Payer: Cash Price |
$69.70
|
| Rate for Payer: Cofinity Commercial |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$74.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.70
|
| Rate for Payer: Healthscope Commercial |
$78.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.05
|
| Rate for Payer: PHP Commercial |
$74.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.63
|
| Rate for Payer: Priority Health SBD |
$54.89
|
| Rate for Payer: UMR Bronson Commercial |
$32.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.34
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
IP
|
$100.08
|
|
|
Service Code
|
NDC 66993066130
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna American Axle |
$65.05
|
| Rate for Payer: Aetna Commercial |
$85.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.05
|
| Rate for Payer: Cash Price |
$80.06
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.07
|
| Rate for Payer: PHP Commercial |
$85.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.05
|
| Rate for Payer: Priority Health SBD |
$63.05
|
| Rate for Payer: UMR Bronson Commercial |
$44.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.06
|
|
|
RALOXIFENE 60 MG TABLET
|
Facility
|
OP
|
$100.08
|
|
|
Service Code
|
NDC 66993066130
|
| Hospital Charge Code |
22143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.03 |
| Max. Negotiated Rate |
$90.07 |
| Rate for Payer: Aetna American Axle |
$65.05
|
| Rate for Payer: Aetna Commercial |
$85.07
|
| Rate for Payer: Aetna Medicare |
$50.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.05
|
| Rate for Payer: BCBS Complete |
$40.03
|
| Rate for Payer: Cash Price |
$80.06
|
| Rate for Payer: Cofinity Commercial |
$70.06
|
| Rate for Payer: Cofinity Commercial |
$86.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.06
|
| Rate for Payer: Healthscope Commercial |
$90.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.07
|
| Rate for Payer: PHP Commercial |
$85.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.05
|
| Rate for Payer: Priority Health SBD |
$63.05
|
| Rate for Payer: UMR Bronson Commercial |
$37.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.06
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,665.28 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna American Axle |
$4,682.25
|
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: Aetna Medicare |
$3,601.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,682.25
|
| Rate for Payer: BCBS Complete |
$2,881.38
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$5,042.42
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,042.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,042.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health SBD |
$4,538.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,665.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,169.52 |
| Max. Negotiated Rate |
$6,483.11 |
| Rate for Payer: Aetna American Axle |
$4,682.25
|
| Rate for Payer: Aetna Commercial |
$6,122.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,682.25
|
| Rate for Payer: Cash Price |
$5,762.77
|
| Rate for Payer: Cofinity Commercial |
$5,042.42
|
| Rate for Payer: Cofinity Commercial |
$6,194.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,042.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$6,483.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,042.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,402.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: PHP Commercial |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health SBD |
$4,538.18
|
| Rate for Payer: UMR Bronson Commercial |
$3,169.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,402.60
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 65862047701
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMIPRIL 10 MG CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65862047701
|
| Hospital Charge Code |
11259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.08 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$48.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UMR Bronson Commercial |
$36.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$82.08
|
|
|
Service Code
|
NDC 68382014406
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$73.87 |
| Rate for Payer: Aetna American Axle |
$53.35
|
| Rate for Payer: Aetna Commercial |
$69.77
|
| Rate for Payer: Aetna Medicare |
$41.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: BCBS Complete |
$32.83
|
| Rate for Payer: Cash Price |
$65.66
|
| Rate for Payer: Cofinity Commercial |
$57.46
|
| Rate for Payer: Cofinity Commercial |
$70.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.66
|
| Rate for Payer: Healthscope Commercial |
$73.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.77
|
| Rate for Payer: PHP Commercial |
$69.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health SBD |
$51.71
|
| Rate for Payer: UMR Bronson Commercial |
$30.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.56
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.56 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.27
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UMR Bronson Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
OP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.27
|
| Rate for Payer: Aetna Commercial |
$91.89
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.27
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: PHP Commercial |
$91.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.27
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UMR Bronson Commercial |
$40.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$62.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna American Axle |
$91.65
|
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
| Rate for Payer: UMR Bronson Commercial |
$52.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.75
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33,032.04
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14,534.10 |
| Max. Negotiated Rate |
$29,728.84 |
| Rate for Payer: Aetna American Axle |
$21,470.83
|
| Rate for Payer: Aetna American Axle |
$4,294.17
|
| Rate for Payer: Aetna Commercial |
$28,077.23
|
| Rate for Payer: Aetna Commercial |
$5,615.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,470.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,294.17
|
| Rate for Payer: Cash Price |
$26,425.63
|
| Rate for Payer: Cash Price |
$5,285.13
|
| Rate for Payer: Cofinity Commercial |
$5,681.51
|
| Rate for Payer: Cofinity Commercial |
$4,624.49
|
| Rate for Payer: Cofinity Commercial |
$23,122.43
|
| Rate for Payer: Cofinity Commercial |
$28,407.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$23,122.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,624.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,425.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,285.13
|
| Rate for Payer: Healthscope Commercial |
$29,728.84
|
| Rate for Payer: Healthscope Commercial |
$5,945.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,122.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,624.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,774.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,954.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,615.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,077.23
|
| Rate for Payer: PHP Commercial |
$5,615.45
|
| Rate for Payer: PHP Commercial |
$28,077.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,470.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,294.17
|
| Rate for Payer: Priority Health SBD |
$20,810.19
|
| Rate for Payer: Priority Health SBD |
$4,162.04
|
| Rate for Payer: UMR Bronson Commercial |
$14,534.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,906.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,774.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,954.81
|
|
|
RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,606.41
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$5,945.77 |
| Rate for Payer: Aetna American Axle |
$4,294.17
|
| Rate for Payer: Aetna American Axle |
$21,470.83
|
| Rate for Payer: Aetna Commercial |
$28,077.23
|
| Rate for Payer: Aetna Commercial |
$5,615.45
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna Medicare |
$77.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,294.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21,470.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.95
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: BCBS Complete |
$41.85
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCBS MAPPO |
$74.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.36
|
| Rate for Payer: Cash Price |
$26,425.63
|
| Rate for Payer: Cash Price |
$5,285.13
|
| Rate for Payer: Cash Price |
$5,285.13
|
| Rate for Payer: Cash Price |
$26,425.63
|
| Rate for Payer: Cofinity Commercial |
$23,122.43
|
| Rate for Payer: Cofinity Commercial |
$28,407.55
|
| Rate for Payer: Cofinity Commercial |
$4,624.49
|
| Rate for Payer: Cofinity Commercial |
$5,681.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$23,122.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,624.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,285.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26,425.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.36
|
| Rate for Payer: Healthscope Commercial |
$5,945.77
|
| Rate for Payer: Healthscope Commercial |
$29,728.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,624.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23,122.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24,774.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,954.81
|
| Rate for Payer: Mclaren Medicaid |
$39.86
|
| Rate for Payer: Mclaren Medicaid |
$39.86
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Mclaren Medicare |
$74.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.08
|
| Rate for Payer: Meridian Medicaid |
$41.85
|
| Rate for Payer: Meridian Medicaid |
$41.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,615.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,077.23
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE Medicare |
$70.64
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PACE SWMI |
$74.36
|
| Rate for Payer: PHP Commercial |
$28,077.23
|
| Rate for Payer: PHP Commercial |
$5,615.45
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: PHP Medicare Advantage |
$74.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21,470.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,294.17
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health Medicare |
$74.36
|
| Rate for Payer: Priority Health SBD |
$20,810.19
|
| Rate for Payer: Priority Health SBD |
$4,162.04
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: Railroad Medicare Medicare |
$74.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.36
|
| Rate for Payer: UHC Exchange |
$142.11
|
| Rate for Payer: UHC Exchange |
$142.11
|
| Rate for Payer: UHC Medicare Advantage |
$74.36
|
| Rate for Payer: UHC Medicare Advantage |
$74.36
|
| Rate for Payer: UHCCP Medicaid |
$39.86
|
| Rate for Payer: UHCCP Medicaid |
$39.86
|
| Rate for Payer: UMR Bronson Commercial |
$12,221.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,444.37
|
| Rate for Payer: VA VA |
$74.36
|
| Rate for Payer: VA VA |
$74.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,954.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24,774.03
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$154.47
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.15 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna American Axle |
$100.41
|
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna Medicare |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.41
|
| Rate for Payer: BCBS Complete |
$61.79
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$108.13
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health SBD |
$97.32
|
| Rate for Payer: UMR Bronson Commercial |
$57.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Commercial |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$523.48 |
| Max. Negotiated Rate |
$1,273.33 |
| Rate for Payer: Aetna American Axle |
$919.63
|
| Rate for Payer: Aetna Commercial |
$1,202.59
|
| Rate for Payer: Aetna Medicare |
$707.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.63
|
| Rate for Payer: BCBS Complete |
$565.92
|
| Rate for Payer: Cash Price |
$1,131.85
|
| Rate for Payer: Cofinity Commercial |
$1,216.74
|
| Rate for Payer: Cofinity Commercial |
$990.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$990.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,131.85
|
| Rate for Payer: Healthscope Commercial |
$1,273.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$990.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,061.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,202.59
|
| Rate for Payer: PHP Commercial |
$1,202.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.63
|
| Rate for Payer: Priority Health SBD |
$891.33
|
| Rate for Payer: UMR Bronson Commercial |
$523.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 70756070360
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$139.02 |
| Rate for Payer: Aetna American Axle |
$100.41
|
| Rate for Payer: Aetna Commercial |
$131.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.41
|
| Rate for Payer: Cash Price |
$123.58
|
| Rate for Payer: Cofinity Commercial |
$108.13
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.58
|
| Rate for Payer: Healthscope Commercial |
$139.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$115.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: PHP Commercial |
$131.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.41
|
| Rate for Payer: Priority Health SBD |
$97.32
|
| Rate for Payer: UMR Bronson Commercial |
$67.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$115.85
|
|
