|
RISPERIDONE 0.25 MG TABLET
|
Facility
|
OP
|
$446.50
|
|
|
Service Code
|
NDC 00904736061
|
| Hospital Charge Code |
25519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna American Axle |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna Medicare |
$223.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| 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 |
$290.22
|
| Rate for Payer: Priority Health SBD |
$281.30
|
| Rate for Payer: UMR Bronson Commercial |
$165.20
|
| 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 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
|
$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 Medicare |
$155.10
|
| 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: 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
|
$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 |
$290.22
|
| Rate for Payer: Aetna Commercial |
$379.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.22
|
| 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 |
$290.22
|
| 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
|
$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
|
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
|
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 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$565.22
|
|
|
Service Code
|
NDC 50458030503
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.70 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna American Axle |
$367.39
|
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.39
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Commercial |
$395.65
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.44
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.39
|
| Rate for Payer: Priority Health SBD |
$356.09
|
| Rate for Payer: UMR Bronson Commercial |
$248.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
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
|
OP
|
$74.45
|
|
|
Service Code
|
NDC 50458059601
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.55 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: Aetna American Axle |
$48.39
|
| Rate for Payer: Aetna Commercial |
$63.28
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.39
|
| Rate for Payer: BCBS Complete |
$29.78
|
| 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 |
$27.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.84
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$565.22
|
|
|
Service Code
|
NDC 50458030503
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.13 |
| Max. Negotiated Rate |
$508.70 |
| Rate for Payer: Aetna American Axle |
$367.39
|
| Rate for Payer: Aetna Commercial |
$480.44
|
| Rate for Payer: Aetna Medicare |
$282.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.39
|
| Rate for Payer: BCBS Complete |
$226.09
|
| Rate for Payer: Cash Price |
$452.18
|
| Rate for Payer: Cofinity Commercial |
$395.65
|
| Rate for Payer: Cofinity Commercial |
$486.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.18
|
| Rate for Payer: Healthscope Commercial |
$508.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.44
|
| Rate for Payer: PHP Commercial |
$480.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.39
|
| Rate for Payer: Priority Health SBD |
$356.09
|
| Rate for Payer: UMR Bronson Commercial |
$209.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.92
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$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
|
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
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna American Axle |
$188.96
|
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: UMR Bronson Commercial |
$127.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.02
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$125.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 68084027211
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$290.70
|
|
|
Service Code
|
NDC 68084027201
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.56 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna American Axle |
$188.96
|
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: BCBS Complete |
$116.28
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.96
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: UMR Bronson Commercial |
$107.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.02
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$211.50
|
|
|
Service Code
|
NDC 27241000106
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: BCBS Complete |
$84.60
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$78.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$17.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$211.50
|
|
|
Service Code
|
NDC 27241000106
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna American Axle |
$137.48
|
| Rate for Payer: Aetna Commercial |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.48
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$148.05
|
| Rate for Payer: Cofinity Commercial |
$181.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.20
|
| Rate for Payer: Healthscope Commercial |
$190.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.78
|
| Rate for Payer: PHP Commercial |
$179.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.48
|
| Rate for Payer: Priority Health SBD |
$133.24
|
| Rate for Payer: UMR Bronson Commercial |
$93.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.62
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.90 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna American Axle |
$219.96
|
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$253.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: UMR Bronson Commercial |
$148.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$253.80
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 68084027211
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$35.53 |
| Rate for Payer: Aetna American Axle |
$25.66
|
| Rate for Payer: Aetna Commercial |
$33.56
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.66
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$27.64
|
| Rate for Payer: Cofinity Commercial |
$33.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$35.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: PHP Commercial |
$33.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: Priority Health SBD |
$24.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.61
|
|
|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$140.59
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.86 |
| Max. Negotiated Rate |
$126.53 |
| Rate for Payer: Aetna American Axle |
$91.38
|
| Rate for Payer: Aetna Commercial |
$119.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.38
|
| Rate for Payer: Cash Price |
$112.47
|
| Rate for Payer: Cofinity Commercial |
$120.91
|
| Rate for Payer: Cofinity Commercial |
$98.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.47
|
| Rate for Payer: Healthscope Commercial |
$126.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.50
|
| Rate for Payer: PHP Commercial |
$119.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.38
|
| Rate for Payer: Priority Health SBD |
$88.57
|
| Rate for Payer: UMR Bronson Commercial |
$61.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.44
|
|
