|
RIFAXIMIN 550 MG TABLET
|
Facility
|
OP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030302
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,159.74 |
| Max. Negotiated Rate |
$10,118.28 |
| Rate for Payer: Aetna American Axle |
$7,307.64
|
| Rate for Payer: Aetna Commercial |
$9,556.15
|
| Rate for Payer: Aetna Medicare |
$5,621.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,307.64
|
| Rate for Payer: BCBS Complete |
$4,497.01
|
| Rate for Payer: Cash Price |
$8,994.02
|
| Rate for Payer: Cofinity Commercial |
$7,869.77
|
| Rate for Payer: Cofinity Commercial |
$9,668.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,869.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.02
|
| Rate for Payer: Healthscope Commercial |
$10,118.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,869.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,431.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,556.15
|
| Rate for Payer: PHP Commercial |
$9,556.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,307.64
|
| Rate for Payer: Priority Health SBD |
$7,082.79
|
| Rate for Payer: UMR Bronson Commercial |
$4,159.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,431.90
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
IP
|
$11,242.53
|
|
|
Service Code
|
NDC 65649030303
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,946.71 |
| Max. Negotiated Rate |
$10,118.28 |
| Rate for Payer: Aetna American Axle |
$7,307.64
|
| Rate for Payer: Aetna Commercial |
$9,556.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,307.64
|
| Rate for Payer: Cash Price |
$8,994.02
|
| Rate for Payer: Cofinity Commercial |
$7,869.77
|
| Rate for Payer: Cofinity Commercial |
$9,668.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,869.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.02
|
| Rate for Payer: Healthscope Commercial |
$10,118.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,869.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,431.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,556.15
|
| Rate for Payer: PHP Commercial |
$9,556.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,307.64
|
| Rate for Payer: Priority Health SBD |
$7,082.79
|
| Rate for Payer: UMR Bronson Commercial |
$4,946.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,431.90
|
|
|
RILPIVIRINE HCL 25 MG TABLET
|
Facility
|
OP
|
$5,351.20
|
|
|
Service Code
|
NDC 59676027801
|
| Hospital Charge Code |
152774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,979.94 |
| Max. Negotiated Rate |
$4,816.08 |
| Rate for Payer: Aetna American Axle |
$3,478.28
|
| Rate for Payer: Aetna Commercial |
$4,548.52
|
| Rate for Payer: Aetna Medicare |
$2,675.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,478.28
|
| Rate for Payer: BCBS Complete |
$2,140.48
|
| Rate for Payer: Cash Price |
$4,280.96
|
| Rate for Payer: Cofinity Commercial |
$3,745.84
|
| Rate for Payer: Cofinity Commercial |
$4,602.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,745.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,280.96
|
| Rate for Payer: Healthscope Commercial |
$4,816.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,745.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,013.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,548.52
|
| Rate for Payer: PHP Commercial |
$4,548.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,478.28
|
| Rate for Payer: Priority Health SBD |
$3,371.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,979.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,013.40
|
|
|
RILPIVIRINE HCL 25 MG TABLET
|
Facility
|
IP
|
$5,351.20
|
|
|
Service Code
|
NDC 59676027801
|
| Hospital Charge Code |
152774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,354.53 |
| Max. Negotiated Rate |
$4,816.08 |
| Rate for Payer: Aetna American Axle |
$3,478.28
|
| Rate for Payer: Aetna Commercial |
$4,548.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,478.28
|
| Rate for Payer: Cash Price |
$4,280.96
|
| Rate for Payer: Cofinity Commercial |
$3,745.84
|
| Rate for Payer: Cofinity Commercial |
$4,602.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,745.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,280.96
|
| Rate for Payer: Healthscope Commercial |
$4,816.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,745.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,013.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,548.52
|
| Rate for Payer: PHP Commercial |
$4,548.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,478.28
|
| Rate for Payer: Priority Health SBD |
$3,371.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,354.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,013.40
|
|
|
RIMANTADINE 100 MG TABLET
|
Facility
|
IP
|
$782.55
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.32 |
| Max. Negotiated Rate |
$704.29 |
| Rate for Payer: Aetna American Axle |
$508.66
|
| Rate for Payer: Aetna Commercial |
$665.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.66
|
| Rate for Payer: Cash Price |
$626.04
|
| Rate for Payer: Cofinity Commercial |
$547.78
|
| Rate for Payer: Cofinity Commercial |
$672.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$547.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$704.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.17
|
| Rate for Payer: PHP Commercial |
$665.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.66
|
| Rate for Payer: Priority Health SBD |
$493.01
|
| Rate for Payer: UMR Bronson Commercial |
$344.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.91
|
|
|
RIMANTADINE 100 MG TABLET
|
Facility
|
OP
|
$782.55
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.54 |
| Max. Negotiated Rate |
$704.29 |
| Rate for Payer: Aetna American Axle |
$508.66
|
| Rate for Payer: Aetna Commercial |
$665.17
|
| Rate for Payer: Aetna Medicare |
$391.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.66
|
| Rate for Payer: BCBS Complete |
$313.02
|
| Rate for Payer: Cash Price |
$626.04
|
| Rate for Payer: Cofinity Commercial |
$547.78
|
| Rate for Payer: Cofinity Commercial |
$672.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$547.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$626.04
|
| Rate for Payer: Healthscope Commercial |
$704.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$665.17
|
| Rate for Payer: PHP Commercial |
$665.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$508.66
|
| Rate for Payer: Priority Health SBD |
$493.01
|
| Rate for Payer: UMR Bronson Commercial |
$289.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.91
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26,969.02
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
200582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,866.37 |
| Max. Negotiated Rate |
$24,272.12 |
| Rate for Payer: Aetna American Axle |
$17,529.86
|
| Rate for Payer: Aetna Commercial |
$22,923.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,529.86
|
| Rate for Payer: Cash Price |
$21,575.22
|
| Rate for Payer: Cofinity Commercial |
$18,878.31
|
| Rate for Payer: Cofinity Commercial |
$23,193.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,575.22
|
| Rate for Payer: Healthscope Commercial |
$24,272.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,878.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,226.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,923.67
|
| Rate for Payer: PHP Commercial |
$22,923.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,529.86
|
| Rate for Payer: Priority Health SBD |
$16,990.48
|
| Rate for Payer: UMR Bronson Commercial |
$11,866.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,226.76
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26,969.02
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
200582
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$24,272.12 |
| Rate for Payer: Aetna American Axle |
$17,529.86
|
| Rate for Payer: Aetna Commercial |
$22,923.67
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,529.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.68
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS MAPPO |
$14.94
|
| Rate for Payer: BCN Medicare Advantage |
$14.94
|
| Rate for Payer: Cash Price |
$21,575.22
|
| Rate for Payer: Cash Price |
$21,575.22
|
| Rate for Payer: Cofinity Commercial |
$23,193.36
|
| Rate for Payer: Cofinity Commercial |
$18,878.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$18,878.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,575.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.94
|
| Rate for Payer: Healthscope Commercial |
$24,272.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18,878.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,226.76
|
| Rate for Payer: Mclaren Medicaid |
$8.01
|
| Rate for Payer: Mclaren Medicare |
$14.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.69
|
| Rate for Payer: Meridian Medicaid |
$8.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,923.67
|
| Rate for Payer: PACE Medicare |
$14.19
|
| Rate for Payer: PACE SWMI |
$14.94
|
| Rate for Payer: PHP Commercial |
$22,923.67
|
| Rate for Payer: PHP Medicare Advantage |
$14.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,529.86
|
| Rate for Payer: Priority Health Medicare |
$14.94
|
| Rate for Payer: Priority Health SBD |
$16,990.48
|
| Rate for Payer: Railroad Medicare Medicare |
$14.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.94
|
| Rate for Payer: UHC Exchange |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$14.94
|
| Rate for Payer: UHCCP Medicaid |
$8.01
|
| Rate for Payer: UMR Bronson Commercial |
$9,978.54
|
| Rate for Payer: VA VA |
$14.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,226.76
|
|
|
RISEDRONATE 150 MG TABLET
|
Facility
|
OP
|
$1,270.88
|
|
|
Service Code
|
NDC 00430047801
|
| Hospital Charge Code |
91538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$470.23 |
| Max. Negotiated Rate |
$1,143.79 |
| Rate for Payer: Aetna American Axle |
$826.07
|
| Rate for Payer: Aetna Commercial |
$1,080.25
|
| Rate for Payer: Aetna Medicare |
$635.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.07
|
| Rate for Payer: BCBS Complete |
$508.35
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cofinity Commercial |
$1,092.96
|
| Rate for Payer: Cofinity Commercial |
$889.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$889.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.70
|
| Rate for Payer: Healthscope Commercial |
$1,143.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$889.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$953.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,080.25
|
| Rate for Payer: PHP Commercial |
$1,080.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.07
|
| Rate for Payer: Priority Health SBD |
$800.65
|
| Rate for Payer: UMR Bronson Commercial |
$470.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$953.16
|
|
|
RISEDRONATE 150 MG TABLET
|
Facility
|
IP
|
$1,270.88
|
|
|
Service Code
|
NDC 00430047801
|
| Hospital Charge Code |
91538
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$559.19 |
| Max. Negotiated Rate |
$1,143.79 |
| Rate for Payer: Aetna American Axle |
$826.07
|
| Rate for Payer: Aetna Commercial |
$1,080.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.07
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cofinity Commercial |
$1,092.96
|
| Rate for Payer: Cofinity Commercial |
$889.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$889.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.70
|
| Rate for Payer: Healthscope Commercial |
$1,143.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$889.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$953.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,080.25
|
| Rate for Payer: PHP Commercial |
$1,080.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.07
|
| Rate for Payer: Priority Health SBD |
$800.65
|
| Rate for Payer: UMR Bronson Commercial |
$559.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$953.16
|
|
|
RISEDRONATE 35 MG TABLET
|
Facility
|
IP
|
$3,526.70
|
|
|
Service Code
|
NDC 00430047207
|
| Hospital Charge Code |
32895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$3,174.03 |
| Rate for Payer: Aetna American Axle |
$2,292.36
|
| Rate for Payer: Aetna Commercial |
$2,997.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.36
|
| Rate for Payer: Cash Price |
$2,821.36
|
| Rate for Payer: Cofinity Commercial |
$2,468.69
|
| Rate for Payer: Cofinity Commercial |
$3,032.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,468.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.36
|
| Rate for Payer: Healthscope Commercial |
$3,174.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,468.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.70
|
| Rate for Payer: PHP Commercial |
$2,997.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.36
|
| Rate for Payer: Priority Health SBD |
$2,221.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,551.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.03
|
|
|
RISEDRONATE 35 MG TABLET
|
Facility
|
OP
|
$3,526.70
|
|
|
Service Code
|
NDC 00430047207
|
| Hospital Charge Code |
32895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,304.88 |
| Max. Negotiated Rate |
$3,174.03 |
| Rate for Payer: Aetna American Axle |
$2,292.36
|
| Rate for Payer: Aetna Commercial |
$2,997.70
|
| Rate for Payer: Aetna Medicare |
$1,763.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,292.36
|
| Rate for Payer: BCBS Complete |
$1,410.68
|
| Rate for Payer: Cash Price |
$2,821.36
|
| Rate for Payer: Cofinity Commercial |
$2,468.69
|
| Rate for Payer: Cofinity Commercial |
$3,032.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,468.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,821.36
|
| Rate for Payer: Healthscope Commercial |
$3,174.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,468.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,645.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,997.70
|
| Rate for Payer: PHP Commercial |
$2,997.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,292.36
|
| Rate for Payer: Priority Health SBD |
$2,221.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,304.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,645.03
|
|
|
RISEDRONATE 5 MG TABLET
|
Facility
|
OP
|
$257.97
|
|
|
Service Code
|
NDC 33342010707
|
| Hospital Charge Code |
27112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.45 |
| Max. Negotiated Rate |
$232.17 |
| Rate for Payer: Aetna American Axle |
$167.68
|
| Rate for Payer: Aetna Commercial |
$219.27
|
| Rate for Payer: Aetna Medicare |
$128.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.68
|
| Rate for Payer: BCBS Complete |
$103.19
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Cofinity Commercial |
$180.58
|
| Rate for Payer: Cofinity Commercial |
$221.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.38
|
| Rate for Payer: Healthscope Commercial |
$232.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.27
|
| Rate for Payer: PHP Commercial |
$219.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.68
|
| Rate for Payer: Priority Health SBD |
$162.52
|
| Rate for Payer: UMR Bronson Commercial |
$95.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.48
|
|
|
RISEDRONATE 5 MG TABLET
|
Facility
|
IP
|
$257.97
|
|
|
Service Code
|
NDC 33342010707
|
| Hospital Charge Code |
27112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$232.17 |
| Rate for Payer: Aetna American Axle |
$167.68
|
| Rate for Payer: Aetna Commercial |
$219.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.68
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Cofinity Commercial |
$180.58
|
| Rate for Payer: Cofinity Commercial |
$221.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.38
|
| Rate for Payer: Healthscope Commercial |
$232.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.27
|
| Rate for Payer: PHP Commercial |
$219.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.68
|
| Rate for Payer: Priority Health SBD |
$162.52
|
| Rate for Payer: UMR Bronson Commercial |
$113.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.48
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Medicare |
$155.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: BCBS Complete |
$124.08
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 00904635761
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.49 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$136.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$38.07
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna American Axle |
$24.75
|
| Rate for Payer: Aetna Commercial |
$32.36
|
| Rate for Payer: Aetna Medicare |
$19.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.75
|
| Rate for Payer: BCBS Complete |
$15.23
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$26.65
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.36
|
| Rate for Payer: PHP Commercial |
$32.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health SBD |
$23.98
|
| Rate for Payer: UMR Bronson Commercial |
$14.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.55
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
NDC 68084027011
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$1.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.69
|
| Rate for Payer: PHP Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 00904736061
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.21 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: BCBS Complete |
$178.60
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$165.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$446.50
|
|
|
Service Code
|
NDC 00904736061
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.46 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.23
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.23
|
| Rate for Payer: Cash Price |
$357.20
|
| Rate for Payer: Cofinity Commercial |
$312.55
|
| Rate for Payer: Cofinity Commercial |
$383.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$312.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$357.20
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$312.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$334.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.52
|
| Rate for Payer: PHP Commercial |
$379.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$290.23
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$196.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$334.88
|
|
|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
NDC 68382011214
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna American Axle |
$24.75
|
| Rate for Payer: Aetna Commercial |
$32.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.75
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$26.65
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.36
|
| Rate for Payer: PHP Commercial |
$32.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health SBD |
$23.98
|
| Rate for Payer: UMR Bronson Commercial |
$16.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.55
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.25 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$41.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$93.75
|
|
|
Service Code
|
NDC 65162067384
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.69 |
| Max. Negotiated Rate |
$84.38 |
| Rate for Payer: Aetna American Axle |
$60.94
|
| Rate for Payer: Aetna Commercial |
$79.69
|
| Rate for Payer: Aetna Medicare |
$46.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.94
|
| Rate for Payer: BCBS Complete |
$37.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cofinity Commercial |
$65.62
|
| Rate for Payer: Cofinity Commercial |
$80.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$84.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.69
|
| Rate for Payer: PHP Commercial |
$79.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.94
|
| Rate for Payer: Priority Health SBD |
$59.06
|
| Rate for Payer: UMR Bronson Commercial |
$34.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.31
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$74.45
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.76 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna American Axle |
$48.39
|
| Rate for Payer: Aetna Commercial |
$63.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.39
|
| Rate for Payer: Cash Price |
$59.56
|
| Rate for Payer: Cofinity Commercial |
$52.12
|
| Rate for Payer: Cofinity Commercial |
$64.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.56
|
| Rate for Payer: Healthscope Commercial |
$67.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.28
|
| Rate for Payer: PHP Commercial |
$63.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.39
|
| Rate for Payer: Priority Health SBD |
$46.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.84
|
|
