|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.87
|
|
|
Service Code
|
NDC 00143925101
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna American Axle |
$14.87
|
| Rate for Payer: Aetna Commercial |
$19.44
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.87
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$20.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.44
|
| Rate for Payer: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.87
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$19.90
|
|
|
Service Code
|
NDC 25021066210
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$17.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.92
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.94
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.92
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860065110
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.59
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$45.53
|
|
|
Service Code
|
NDC 70860065110
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: BCBS Complete |
$18.21
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.59
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$45.53
|
|
|
Service Code
|
NDC 70860065142
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: BCBS Complete |
$18.21
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.59
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$74.31
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$66.88 |
| Rate for Payer: Aetna American Axle |
$48.30
|
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.30
|
| Rate for Payer: Cash Price |
$59.45
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.45
|
| Rate for Payer: Healthscope Commercial |
$66.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.16
|
| Rate for Payer: PHP Commercial |
$63.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$32.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.73
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$653.04 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna American Axle |
$964.72
|
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.72
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,038.93
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,038.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health SBD |
$935.04
|
| Rate for Payer: UMR Bronson Commercial |
$653.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.14
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$549.15 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna American Axle |
$964.72
|
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna Medicare |
$742.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.72
|
| Rate for Payer: BCBS Complete |
$593.68
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,038.93
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,038.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health SBD |
$935.04
|
| Rate for Payer: UMR Bronson Commercial |
$549.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.14
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$74.31
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.49 |
| Max. Negotiated Rate |
$66.88 |
| Rate for Payer: Aetna American Axle |
$48.30
|
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: Aetna Medicare |
$37.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.30
|
| Rate for Payer: BCBS Complete |
$29.72
|
| Rate for Payer: Cash Price |
$59.45
|
| Rate for Payer: Cofinity Commercial |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$63.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.45
|
| Rate for Payer: Healthscope Commercial |
$66.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.16
|
| Rate for Payer: PHP Commercial |
$63.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.30
|
| Rate for Payer: Priority Health SBD |
$46.82
|
| Rate for Payer: UMR Bronson Commercial |
$27.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.73
|
|
|
ROMIPLOSTIM 125 MCG/1 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
OP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
301226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,629.65 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna American Axle |
$2,862.89
|
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna Medicare |
$2,202.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: BCBS Complete |
$1,761.78
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,083.12
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Healthscope Commercial |
$3,964.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,083.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,303.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,629.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,303.34
|
|
|
ROMIPLOSTIM 125 MCG/1 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
IP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
301226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,937.96 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna American Axle |
$2,862.89
|
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,083.12
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Healthscope Commercial |
$3,964.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,083.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,303.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,937.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,303.34
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna American Axle |
$2,862.89
|
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$28.42
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Commercial |
$3,083.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$3,964.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,083.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,303.34
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: Nomi Health Commercial |
$31.62
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,629.65
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,303.34
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,937.96 |
| Max. Negotiated Rate |
$3,964.00 |
| Rate for Payer: Aetna American Axle |
$2,862.89
|
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,083.12
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Healthscope Commercial |
$3,964.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,083.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,303.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,937.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,303.34
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,157.13
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$6,441.42 |
| Rate for Payer: Aetna American Axle |
$4,652.13
|
| Rate for Payer: Aetna Commercial |
$6,083.56
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,652.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$28.42
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cofinity Commercial |
$6,155.13
|
| Rate for Payer: Cofinity Commercial |
$5,009.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,009.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,725.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$6,441.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,009.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,367.85
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,083.56
|
| Rate for Payer: Nomi Health Commercial |
$31.62
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$6,083.56
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,652.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Priority Health SBD |
$4,508.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$2,648.14
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,367.85
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,157.13
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,149.14 |
| Max. Negotiated Rate |
$6,441.42 |
| Rate for Payer: Aetna American Axle |
$4,652.13
|
| Rate for Payer: Aetna Commercial |
$6,083.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,652.13
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cofinity Commercial |
$5,009.99
|
| Rate for Payer: Cofinity Commercial |
$6,155.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,009.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,725.70
|
| Rate for Payer: Healthscope Commercial |
$6,441.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,009.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,367.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,083.56
|
| Rate for Payer: PHP Commercial |
$6,083.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,652.13
|
| Rate for Payer: Priority Health SBD |
$4,508.99
|
| Rate for Payer: UMR Bronson Commercial |
$3,149.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,367.85
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$14,314.23
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,298.26 |
| Max. Negotiated Rate |
$12,882.81 |
| Rate for Payer: Aetna American Axle |
$9,304.25
|
| Rate for Payer: Aetna Commercial |
$12,167.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,304.25
|
| Rate for Payer: Cash Price |
$11,451.38
|
| Rate for Payer: Cofinity Commercial |
$10,019.96
|
| Rate for Payer: Cofinity Commercial |
$12,310.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,451.38
|
| Rate for Payer: Healthscope Commercial |
$12,882.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,735.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,167.10
|
| Rate for Payer: PHP Commercial |
$12,167.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,304.25
|
| Rate for Payer: Priority Health SBD |
$9,017.96
|
| Rate for Payer: UMR Bronson Commercial |
$6,298.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,735.67
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$14,314.23
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$12,882.81 |
| Rate for Payer: Aetna American Axle |
$9,304.25
|
| Rate for Payer: Aetna Commercial |
$12,167.10
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,304.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$28.42
|
| Rate for Payer: BCN Commercial |
$28.42
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$11,451.38
|
| Rate for Payer: Cash Price |
$11,451.38
|
| Rate for Payer: Cofinity Commercial |
$12,310.24
|
| Rate for Payer: Cofinity Commercial |
$10,019.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,019.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,451.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$12,882.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,019.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,735.67
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,167.10
|
| Rate for Payer: Nomi Health Commercial |
$31.62
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$12,167.10
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,304.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.08
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$23.26
|
| Rate for Payer: Priority Health SBD |
$9,017.96
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Exchange |
$20.14
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$5,296.27
|
| Rate for Payer: VA VA |
$10.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,735.67
|
|
|
ROMOSOZUMAB-AQQG 105 MG/1.17 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190174
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna American Axle |
$2,603.89
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$30.96
|
| Rate for Payer: BCN Commercial |
$30.96
|
| Rate for Payer: BCN Medicare Advantage |
$11.49
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Commercial |
$2,804.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.49
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$34.47
|
| Rate for Payer: PACE Medicare |
$10.92
|
| Rate for Payer: PACE SWMI |
$11.49
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Narrow Network |
$25.73
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.49
|
| Rate for Payer: UHC Exchange |
$21.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,482.22
|
| Rate for Payer: VA VA |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna American Axle |
$2,603.89
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$30.96
|
| Rate for Payer: BCN Commercial |
$30.96
|
| Rate for Payer: BCN Medicare Advantage |
$11.49
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Commercial |
$2,804.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.49
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$34.47
|
| Rate for Payer: PACE Medicare |
$10.92
|
| Rate for Payer: PACE SWMI |
$11.49
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Narrow Network |
$25.73
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: Railroad Medicare Medicare |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.49
|
| Rate for Payer: UHC Exchange |
$21.96
|
| Rate for Payer: UHC Medicare Advantage |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,482.22
|
| Rate for Payer: VA VA |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,762.64 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna American Axle |
$2,603.89
|
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,603.89
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$2,804.19
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,804.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health SBD |
$2,523.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,762.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$355.30
|
|
|
Service Code
|
NDC 60687057701
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna Medicare |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: BCBS Complete |
$142.12
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$131.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 68462025301
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna American Axle |
$174.14
|
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.14
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: UMR Bronson Commercial |
$117.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.92
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$3.56
|
|
|
Service Code
|
NDC 60687057711
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna American Axle |
$2.31
|
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.31
|
| Rate for Payer: BCBS Complete |
$1.42
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$3.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.85
|
| Rate for Payer: Healthscope Commercial |
$3.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.31
|
| Rate for Payer: Priority Health SBD |
$2.24
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.67
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 60687057701
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.33 |
| Max. Negotiated Rate |
$319.77 |
| Rate for Payer: Aetna American Axle |
$230.94
|
| Rate for Payer: Aetna Commercial |
$302.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.94
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$248.71
|
| Rate for Payer: Cofinity Commercial |
$305.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$319.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.00
|
| Rate for Payer: PHP Commercial |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.94
|
| Rate for Payer: Priority Health SBD |
$223.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.48
|
|
