|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$449.76
|
|
|
Service Code
|
NDC 00904678061
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.89 |
| Max. Negotiated Rate |
$404.78 |
| Rate for Payer: Aetna American Axle |
$292.34
|
| Rate for Payer: Aetna Commercial |
$382.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.34
|
| Rate for Payer: Cash Price |
$359.81
|
| Rate for Payer: Cofinity Advantage |
$314.83
|
| Rate for Payer: Cofinity Commercial |
$386.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.81
|
| Rate for Payer: Healthscope Commercial |
$404.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.32
|
| Rate for Payer: PHP Commercial |
$382.30
|
| Rate for Payer: Priority Health SBD |
$283.35
|
| Rate for Payer: UMR Bronson Commercial |
$197.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.32
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$573.60
|
|
|
Service Code
|
NDC 00904678161
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.23 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Aetna American Axle |
$372.84
|
| Rate for Payer: Aetna Commercial |
$487.56
|
| Rate for Payer: Aetna Medicare |
$286.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.84
|
| Rate for Payer: BCBS Complete |
$229.44
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Advantage |
$401.52
|
| Rate for Payer: Cofinity Commercial |
$493.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$516.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$458.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.20
|
| Rate for Payer: PHP Commercial |
$487.56
|
| Rate for Payer: Priority Health SBD |
$361.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.84
|
| Rate for Payer: UHC Core |
$298.85
|
| Rate for Payer: UHC Exchange |
$225.42
|
| Rate for Payer: UMR Bronson Commercial |
$212.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.20
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 50268071111
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna American Axle |
$2.38
|
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.38
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Advantage |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 50268071111
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna American Axle |
$2.38
|
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.38
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Advantage |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.93
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.11
|
| Rate for Payer: Priority Health SBD |
$2.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.38
|
| Rate for Payer: UHC Core |
$1.91
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$573.60
|
|
|
Service Code
|
NDC 00904678161
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.38 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Aetna American Axle |
$372.84
|
| Rate for Payer: Aetna Commercial |
$487.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.84
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Advantage |
$401.52
|
| Rate for Payer: Cofinity Commercial |
$493.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$516.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.20
|
| Rate for Payer: PHP Commercial |
$487.56
|
| Rate for Payer: Priority Health SBD |
$361.37
|
| Rate for Payer: UMR Bronson Commercial |
$252.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.20
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$182.88
|
|
|
Service Code
|
NDC 50268071115
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna American Axle |
$118.87
|
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.87
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Advantage |
$128.02
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.30
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.16
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: Priority Health SBD |
$115.21
|
| Rate for Payer: UMR Bronson Commercial |
$80.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.16
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$182.88
|
|
|
Service Code
|
NDC 50268071115
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.67 |
| Max. Negotiated Rate |
$164.59 |
| Rate for Payer: Aetna American Axle |
$118.87
|
| Rate for Payer: Aetna Commercial |
$155.45
|
| Rate for Payer: Aetna Medicare |
$91.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.87
|
| Rate for Payer: BCBS Complete |
$73.15
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cofinity Advantage |
$128.02
|
| Rate for Payer: Cofinity Commercial |
$157.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.30
|
| Rate for Payer: Healthscope Commercial |
$164.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.16
|
| Rate for Payer: PHP Commercial |
$155.45
|
| Rate for Payer: Priority Health SBD |
$115.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.87
|
| Rate for Payer: UHC Core |
$95.28
|
| Rate for Payer: UHC Exchange |
$71.87
|
| Rate for Payer: UMR Bronson Commercial |
$67.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.16
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$133.25
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Advantage |
$93.28
|
| Rate for Payer: Cofinity Commercial |
$114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.94
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.61
|
| Rate for Payer: UHC Core |
$69.42
|
| Rate for Payer: UHC Exchange |
$52.37
|
| Rate for Payer: UMR Bronson Commercial |
$49.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Advantage |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna Medicare |
$46.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: BCBS Complete |
$37.22
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Advantage |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.49
|
| Rate for Payer: UHC Core |
$48.48
|
| Rate for Payer: UHC Exchange |
$36.57
|
| Rate for Payer: UMR Bronson Commercial |
$34.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$133.25
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Advantage |
$93.28
|
| Rate for Payer: Cofinity Commercial |
$114.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.94
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UMR Bronson Commercial |
$58.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION
|
Facility
|
IP
|
$304.60
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$274.14 |
| Rate for Payer: Aetna American Axle |
$197.99
|
| Rate for Payer: Aetna Commercial |
$258.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.99
|
| Rate for Payer: Cash Price |
$243.68
|
| Rate for Payer: Cofinity Advantage |
$213.22
|
| Rate for Payer: Cofinity Commercial |
$261.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.68
|
| Rate for Payer: Healthscope Commercial |
$274.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.45
|
| Rate for Payer: PHP Commercial |
$258.91
|
| Rate for Payer: Priority Health SBD |
$191.90
|
| Rate for Payer: UMR Bronson Commercial |
$134.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.45
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION
|
Facility
|
OP
|
$304.60
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$326.98 |
| Rate for Payer: Aetna American Axle |
$197.99
|
| Rate for Payer: Aetna Commercial |
$258.91
|
| Rate for Payer: Aetna Medicare |
$152.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.99
|
| Rate for Payer: BCBS Complete |
$121.84
|
| Rate for Payer: BCBS Trust/PPO |
$326.98
|
| Rate for Payer: BCN Commercial |
$326.98
|
| Rate for Payer: Cash Price |
$243.68
|
| Rate for Payer: Cash Price |
$243.68
|
| Rate for Payer: Cofinity Advantage |
$213.22
|
| Rate for Payer: Cofinity Commercial |
$261.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.68
|
| Rate for Payer: Healthscope Commercial |
$274.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$228.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.45
|
| Rate for Payer: PHP Commercial |
$258.91
|
| Rate for Payer: Priority Health SBD |
$191.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.18
|
| Rate for Payer: UHC Core |
$203.18
|
| Rate for Payer: UHC Exchange |
$203.18
|
| Rate for Payer: UMR Bronson Commercial |
$112.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$228.45
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
OP
|
$803.52
|
|
|
Service Code
|
NDC 31722059812
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.30 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna American Axle |
$522.29
|
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Aetna Medicare |
$401.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.29
|
| Rate for Payer: BCBS Complete |
$321.41
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Advantage |
$562.46
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.64
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: Priority Health SBD |
$506.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.29
|
| Rate for Payer: UHC Core |
$418.63
|
| Rate for Payer: UHC Exchange |
$315.78
|
| Rate for Payer: UMR Bronson Commercial |
$297.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
IP
|
$803.52
|
|
|
Service Code
|
NDC 31722059812
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.55 |
| Max. Negotiated Rate |
$723.17 |
| Rate for Payer: Aetna American Axle |
$522.29
|
| Rate for Payer: Aetna Commercial |
$682.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.29
|
| Rate for Payer: Cash Price |
$642.82
|
| Rate for Payer: Cofinity Advantage |
$562.46
|
| Rate for Payer: Cofinity Commercial |
$691.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$642.82
|
| Rate for Payer: Healthscope Commercial |
$723.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$562.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$682.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$602.64
|
| Rate for Payer: PHP Commercial |
$682.99
|
| Rate for Payer: Priority Health SBD |
$506.22
|
| Rate for Payer: UMR Bronson Commercial |
$353.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$602.64
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
OP
|
$5,450.55
|
|
|
Service Code
|
NDC 62856058252
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,016.70 |
| Max. Negotiated Rate |
$4,905.49 |
| Rate for Payer: Aetna American Axle |
$3,542.86
|
| Rate for Payer: Aetna Commercial |
$4,632.97
|
| Rate for Payer: Aetna Medicare |
$2,725.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.86
|
| Rate for Payer: BCBS Complete |
$2,180.22
|
| Rate for Payer: Cash Price |
$4,360.44
|
| Rate for Payer: Cofinity Advantage |
$3,815.39
|
| Rate for Payer: Cofinity Commercial |
$4,687.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,360.44
|
| Rate for Payer: Healthscope Commercial |
$4,905.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,815.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,087.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,360.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,632.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,087.91
|
| Rate for Payer: PHP Commercial |
$4,632.97
|
| Rate for Payer: Priority Health SBD |
$3,433.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,542.86
|
| Rate for Payer: UHC Core |
$2,839.74
|
| Rate for Payer: UHC Exchange |
$2,142.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,016.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,087.91
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
IP
|
$5,450.55
|
|
|
Service Code
|
NDC 62856058252
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,398.24 |
| Max. Negotiated Rate |
$4,905.49 |
| Rate for Payer: Aetna American Axle |
$3,542.86
|
| Rate for Payer: Aetna Commercial |
$4,632.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.86
|
| Rate for Payer: Cash Price |
$4,360.44
|
| Rate for Payer: Cofinity Advantage |
$3,815.39
|
| Rate for Payer: Cofinity Commercial |
$4,687.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,360.44
|
| Rate for Payer: Healthscope Commercial |
$4,905.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,815.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,087.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,632.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,087.91
|
| Rate for Payer: PHP Commercial |
$4,632.97
|
| Rate for Payer: Priority Health SBD |
$3,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,398.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,087.91
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$1,394.61
|
|
|
Service Code
|
NDC 59651061708
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$613.63 |
| Max. Negotiated Rate |
$1,255.15 |
| Rate for Payer: Aetna American Axle |
$906.50
|
| Rate for Payer: Aetna Commercial |
$1,185.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.50
|
| Rate for Payer: Cash Price |
$1,115.69
|
| Rate for Payer: Cofinity Advantage |
$976.23
|
| Rate for Payer: Cofinity Commercial |
$1,199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.69
|
| Rate for Payer: Healthscope Commercial |
$1,255.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$976.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,045.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.96
|
| Rate for Payer: PHP Commercial |
$1,185.42
|
| Rate for Payer: Priority Health SBD |
$878.60
|
| Rate for Payer: UMR Bronson Commercial |
$613.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,045.96
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$2,536.13
|
|
|
Service Code
|
NDC 00054042623
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,115.90 |
| Max. Negotiated Rate |
$2,282.52 |
| Rate for Payer: Aetna American Axle |
$1,648.48
|
| Rate for Payer: Aetna Commercial |
$2,155.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.48
|
| Rate for Payer: Cash Price |
$2,028.90
|
| Rate for Payer: Cofinity Advantage |
$1,775.29
|
| Rate for Payer: Cofinity Commercial |
$2,181.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.90
|
| Rate for Payer: Healthscope Commercial |
$2,282.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,155.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,902.10
|
| Rate for Payer: PHP Commercial |
$2,155.71
|
| Rate for Payer: Priority Health SBD |
$1,597.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.10
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$10,901.09
|
|
|
Service Code
|
NDC 62856058352
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,796.48 |
| Max. Negotiated Rate |
$9,810.98 |
| Rate for Payer: Aetna American Axle |
$7,085.71
|
| Rate for Payer: Aetna Commercial |
$9,265.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,085.71
|
| Rate for Payer: Cash Price |
$8,720.87
|
| Rate for Payer: Cofinity Advantage |
$7,630.76
|
| Rate for Payer: Cofinity Commercial |
$9,374.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,720.87
|
| Rate for Payer: Healthscope Commercial |
$9,810.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,630.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,175.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,265.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,175.82
|
| Rate for Payer: PHP Commercial |
$9,265.93
|
| Rate for Payer: Priority Health SBD |
$6,867.69
|
| Rate for Payer: UMR Bronson Commercial |
$4,796.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,175.82
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$1,394.61
|
|
|
Service Code
|
NDC 59651061708
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$516.01 |
| Max. Negotiated Rate |
$1,255.15 |
| Rate for Payer: Aetna American Axle |
$906.50
|
| Rate for Payer: Aetna Commercial |
$1,185.42
|
| Rate for Payer: Aetna Medicare |
$697.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.50
|
| Rate for Payer: BCBS Complete |
$557.84
|
| Rate for Payer: Cash Price |
$1,115.69
|
| Rate for Payer: Cofinity Advantage |
$976.23
|
| Rate for Payer: Cofinity Commercial |
$1,199.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,115.69
|
| Rate for Payer: Healthscope Commercial |
$1,255.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$976.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,045.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,115.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,185.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,045.96
|
| Rate for Payer: PHP Commercial |
$1,185.42
|
| Rate for Payer: Priority Health SBD |
$878.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.50
|
| Rate for Payer: UHC Core |
$726.59
|
| Rate for Payer: UHC Exchange |
$548.08
|
| Rate for Payer: UMR Bronson Commercial |
$516.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,045.96
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$10,901.09
|
|
|
Service Code
|
NDC 62856058352
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,033.40 |
| Max. Negotiated Rate |
$9,810.98 |
| Rate for Payer: Aetna American Axle |
$7,085.71
|
| Rate for Payer: Aetna Commercial |
$9,265.93
|
| Rate for Payer: Aetna Medicare |
$5,450.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,085.71
|
| Rate for Payer: BCBS Complete |
$4,360.44
|
| Rate for Payer: Cash Price |
$8,720.87
|
| Rate for Payer: Cofinity Advantage |
$7,630.76
|
| Rate for Payer: Cofinity Commercial |
$9,374.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,720.87
|
| Rate for Payer: Healthscope Commercial |
$9,810.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,630.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,175.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,720.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,265.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,175.82
|
| Rate for Payer: PHP Commercial |
$9,265.93
|
| Rate for Payer: Priority Health SBD |
$6,867.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,085.71
|
| Rate for Payer: UHC Core |
$5,679.47
|
| Rate for Payer: UHC Exchange |
$4,284.13
|
| Rate for Payer: UMR Bronson Commercial |
$4,033.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,175.82
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$2,536.13
|
|
|
Service Code
|
NDC 00054042623
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$938.37 |
| Max. Negotiated Rate |
$2,282.52 |
| Rate for Payer: Aetna American Axle |
$1,648.48
|
| Rate for Payer: Aetna Commercial |
$2,155.71
|
| Rate for Payer: Aetna Medicare |
$1,268.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.48
|
| Rate for Payer: BCBS Complete |
$1,014.45
|
| Rate for Payer: Cash Price |
$2,028.90
|
| Rate for Payer: Cofinity Advantage |
$1,775.29
|
| Rate for Payer: Cofinity Commercial |
$2,181.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.90
|
| Rate for Payer: Healthscope Commercial |
$2,282.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,028.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,155.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,902.10
|
| Rate for Payer: PHP Commercial |
$2,155.71
|
| Rate for Payer: Priority Health SBD |
$1,597.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,648.48
|
| Rate for Payer: UHC Core |
$1,321.32
|
| Rate for Payer: UHC Exchange |
$996.70
|
| Rate for Payer: UMR Bronson Commercial |
$938.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.10
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,740.32
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
193479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,165.74 |
| Max. Negotiated Rate |
$10,566.29 |
| Rate for Payer: Aetna American Axle |
$7,631.21
|
| Rate for Payer: Aetna Commercial |
$9,979.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,631.21
|
| Rate for Payer: Cash Price |
$9,392.26
|
| Rate for Payer: Cofinity Advantage |
$8,218.22
|
| Rate for Payer: Cofinity Commercial |
$10,096.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,392.26
|
| Rate for Payer: Healthscope Commercial |
$10,566.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,218.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,805.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,979.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,805.24
|
| Rate for Payer: PHP Commercial |
$9,979.27
|
| Rate for Payer: Priority Health SBD |
$7,396.40
|
| Rate for Payer: UMR Bronson Commercial |
$5,165.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,805.24
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,740.32
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
193479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$10,566.29 |
| Rate for Payer: Aetna American Axle |
$7,631.21
|
| Rate for Payer: Aetna Commercial |
$9,979.27
|
| Rate for Payer: Aetna Medicare |
$38.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,631.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.00
|
| Rate for Payer: BCBS Complete |
$20.21
|
| Rate for Payer: BCBS MAPPO |
$36.80
|
| Rate for Payer: BCBS Trust/PPO |
$119.89
|
| Rate for Payer: BCN Commercial |
$119.89
|
| Rate for Payer: BCN Medicare Advantage |
$36.80
|
| Rate for Payer: Cash Price |
$9,392.26
|
| Rate for Payer: Cash Price |
$9,392.26
|
| Rate for Payer: Cofinity Advantage |
$8,218.22
|
| Rate for Payer: Cofinity Commercial |
$10,096.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,392.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.80
|
| Rate for Payer: Healthscope Commercial |
$10,566.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,218.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,805.24
|
| Rate for Payer: Mclaren Medicaid |
$36.80
|
| Rate for Payer: Mclaren Medicare |
$36.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.64
|
| Rate for Payer: Meridian Medicaid |
$38.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,979.27
|
| Rate for Payer: Nomi Health Commercial |
$110.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,805.24
|
| Rate for Payer: PACE Medicare |
$34.96
|
| Rate for Payer: PACE SWMI |
$36.80
|
| Rate for Payer: PHP Commercial |
$9,979.27
|
| Rate for Payer: PHP Medicare Advantage |
$36.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$114.41
|
| Rate for Payer: Priority Health Medicare |
$36.80
|
| Rate for Payer: Priority Health SBD |
$7,396.40
|
| Rate for Payer: Priority Health Tiered Network |
$91.53
|
| Rate for Payer: Railroad Medicare Medicare |
$36.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.02
|
| Rate for Payer: UHC Core |
$61.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.80
|
| Rate for Payer: UHC Exchange |
$61.02
|
| Rate for Payer: UHC Medicaid |
$19.25
|
| Rate for Payer: UHCCP Medicaid |
$19.25
|
| Rate for Payer: UMR Bronson Commercial |
$4,343.92
|
| Rate for Payer: VA VA |
$36.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,805.24
|
|
