|
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 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 |
$70.26
|
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.26
|
| 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 |
$91.88
|
| Rate for Payer: PHP Commercial |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.26
|
| 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 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 |
$70.26
|
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.26
|
| 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 |
$91.88
|
| Rate for Payer: PHP Commercial |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.26
|
| 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 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
|
OP
|
$33,032.04
|
|
|
Service Code
|
HCPCS J9308
|
| Hospital Charge Code |
170507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.08 |
| 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 |
$5,615.45
|
| Rate for Payer: Aetna Commercial |
$28,077.23
|
| Rate for Payer: Aetna Medicare |
$75.83
|
| Rate for Payer: Aetna Medicare |
$75.83
|
| 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: Allen County Amish Medical Aid Commercial |
$91.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91.14
|
| Rate for Payer: BCBS Complete |
$41.03
|
| Rate for Payer: BCBS Complete |
$41.03
|
| Rate for Payer: BCBS MAPPO |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$72.91
|
| Rate for Payer: BCBS Trust/PPO |
$188.08
|
| Rate for Payer: BCBS Trust/PPO |
$188.08
|
| Rate for Payer: BCN Commercial |
$188.08
|
| Rate for Payer: BCN Commercial |
$188.08
|
| Rate for Payer: BCN Medicare Advantage |
$72.91
|
| Rate for Payer: BCN Medicare Advantage |
$72.91
|
| Rate for Payer: Cash Price |
$5,285.13
|
| Rate for Payer: Cash Price |
$26,425.63
|
| Rate for Payer: Cash Price |
$5,285.13
|
| Rate for Payer: Cash Price |
$26,425.63
|
| 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 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 |
$26,425.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,285.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.91
|
| 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 |
$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 |
$39.08
|
| Rate for Payer: Mclaren Medicaid |
$39.08
|
| Rate for Payer: Mclaren Medicare |
$72.91
|
| Rate for Payer: Mclaren Medicare |
$72.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.56
|
| Rate for Payer: Meridian Medicaid |
$41.03
|
| Rate for Payer: Meridian Medicaid |
$41.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,077.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,615.45
|
| Rate for Payer: Nomi Health Commercial |
$218.73
|
| Rate for Payer: Nomi Health Commercial |
$218.73
|
| Rate for Payer: PACE Medicare |
$69.26
|
| Rate for Payer: PACE Medicare |
$69.26
|
| Rate for Payer: PACE SWMI |
$72.91
|
| Rate for Payer: PACE SWMI |
$72.91
|
| Rate for Payer: PHP Commercial |
$28,077.23
|
| Rate for Payer: PHP Commercial |
$5,615.45
|
| Rate for Payer: PHP Medicare Advantage |
$72.91
|
| Rate for Payer: PHP Medicare Advantage |
$72.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.08
|
| 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 HMO/PPO/Tiered Network |
$204.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.53
|
| Rate for Payer: Priority Health Medicare |
$72.91
|
| Rate for Payer: Priority Health Medicare |
$72.91
|
| Rate for Payer: Priority Health Narrow Network |
$163.62
|
| Rate for Payer: Priority Health Narrow Network |
$163.62
|
| Rate for Payer: Priority Health SBD |
$20,810.19
|
| Rate for Payer: Priority Health SBD |
$4,162.04
|
| Rate for Payer: Railroad Medicare Medicare |
$72.91
|
| Rate for Payer: Railroad Medicare Medicare |
$72.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.91
|
| Rate for Payer: UHC Exchange |
$139.34
|
| Rate for Payer: UHC Exchange |
$139.34
|
| Rate for Payer: UHC Medicare Advantage |
$72.91
|
| Rate for Payer: UHC Medicare Advantage |
$72.91
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: UHCCP Medicaid |
$39.08
|
| Rate for Payer: UMR Bronson Commercial |
$12,221.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,444.37
|
| Rate for Payer: VA VA |
$72.91
|
| Rate for Payer: VA VA |
$72.91
|
| 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
|
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
|
|
|
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 |
$77.24
|
| 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
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| 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 |
$77.24
|
| 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
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$77.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
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
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$65.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
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
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.98 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna American Axle |
$247.67
|
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna Medicare |
$190.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: BCBS Complete |
$152.41
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.67
|
| Rate for Payer: Priority Health SBD |
$240.05
|
| Rate for Payer: UMR Bronson Commercial |
$140.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$154.47
|
|
|
Service Code
|
NDC 31722066860
|
| 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
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| 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 |
$2.60
|
| 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
|
$381.03
|
|
|
Service Code
|
NDC 45963041806
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.65 |
| Max. Negotiated Rate |
$342.93 |
| Rate for Payer: Aetna American Axle |
$247.67
|
| Rate for Payer: Aetna Commercial |
$323.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.67
|
| Rate for Payer: Cash Price |
$304.82
|
| Rate for Payer: Cofinity Commercial |
$266.72
|
| Rate for Payer: Cofinity Commercial |
$327.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$266.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.82
|
| Rate for Payer: Healthscope Commercial |
$342.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.88
|
| Rate for Payer: PHP Commercial |
$323.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.67
|
| Rate for Payer: Priority Health SBD |
$240.05
|
| Rate for Payer: UMR Bronson Commercial |
$167.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.77
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$1,414.81
|
|
|
Service Code
|
NDC 61958100301
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$622.52 |
| 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 New Business (MI Preferred) |
$919.63
|
| 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 |
$622.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,061.11
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$295.93
|
|
|
Service Code
|
NDC 23155074603
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Medicare |
$147.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: BCBS Complete |
$118.37
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.35
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$109.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$342.44
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna American Axle |
$222.59
|
| Rate for Payer: Aetna Commercial |
$291.07
|
| Rate for Payer: Aetna Medicare |
$171.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.59
|
| Rate for Payer: BCBS Complete |
$136.98
|
| Rate for Payer: Cash Price |
$273.95
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Commercial |
$294.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.95
|
| Rate for Payer: Healthscope Commercial |
$308.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.07
|
| Rate for Payer: PHP Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.59
|
| Rate for Payer: Priority Health SBD |
$215.74
|
| Rate for Payer: UMR Bronson Commercial |
$126.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.83
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$4,305.03
|
|
|
Service Code
|
NDC 68546014256
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,592.86 |
| Max. Negotiated Rate |
$3,874.53 |
| Rate for Payer: Aetna American Axle |
$2,798.27
|
| Rate for Payer: Aetna Commercial |
$3,659.28
|
| Rate for Payer: Aetna Medicare |
$2,152.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,798.27
|
| Rate for Payer: BCBS Complete |
$1,722.01
|
| Rate for Payer: Cash Price |
$3,444.02
|
| Rate for Payer: Cofinity Commercial |
$3,013.52
|
| Rate for Payer: Cofinity Commercial |
$3,702.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,013.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,444.02
|
| Rate for Payer: Healthscope Commercial |
$3,874.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,013.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,228.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,659.28
|
| Rate for Payer: PHP Commercial |
$3,659.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,798.27
|
| Rate for Payer: Priority Health SBD |
$2,712.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,592.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,228.77
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$295.93
|
|
|
Service Code
|
NDC 23155074603
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.21 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.35
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$130.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$1,417.59
|
|
|
Service Code
|
NDC 00378127093
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$524.51 |
| Max. Negotiated Rate |
$1,275.83 |
| Rate for Payer: Aetna American Axle |
$921.43
|
| Rate for Payer: Aetna Commercial |
$1,204.95
|
| Rate for Payer: Aetna Medicare |
$708.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.43
|
| Rate for Payer: BCBS Complete |
$567.04
|
| Rate for Payer: Cash Price |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,219.13
|
| Rate for Payer: Cofinity Commercial |
$992.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$992.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.07
|
| Rate for Payer: Healthscope Commercial |
$1,275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,204.95
|
| Rate for Payer: PHP Commercial |
$1,204.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.43
|
| Rate for Payer: Priority Health SBD |
$893.08
|
| Rate for Payer: UMR Bronson Commercial |
$524.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.19
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
IP
|
$342.44
|
|
|
Service Code
|
NDC 67877025930
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna American Axle |
$222.59
|
| Rate for Payer: Aetna Commercial |
$291.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.59
|
| Rate for Payer: Cash Price |
$273.95
|
| Rate for Payer: Cofinity Commercial |
$239.71
|
| Rate for Payer: Cofinity Commercial |
$294.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.95
|
| Rate for Payer: Healthscope Commercial |
$308.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.07
|
| Rate for Payer: PHP Commercial |
$291.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.59
|
| Rate for Payer: Priority Health SBD |
$215.74
|
| Rate for Payer: UMR Bronson Commercial |
$150.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.83
|
|
