|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$224.19
|
|
|
Service Code
|
NDC 27808015701
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$201.77 |
| Rate for Payer: Aetna American Axle |
$145.72
|
| Rate for Payer: Aetna Commercial |
$190.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.72
|
| Rate for Payer: Cash Price |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$156.93
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.35
|
| Rate for Payer: Healthscope Commercial |
$201.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.56
|
| Rate for Payer: PHP Commercial |
$190.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.72
|
| Rate for Payer: Priority Health SBD |
$141.24
|
| Rate for Payer: UMR Bronson Commercial |
$98.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.14
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$449.76
|
|
|
Service Code
|
NDC 00904678061
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.41 |
| Max. Negotiated Rate |
$404.78 |
| Rate for Payer: Aetna American Axle |
$292.34
|
| Rate for Payer: Aetna Commercial |
$382.30
|
| Rate for Payer: Aetna Medicare |
$224.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.34
|
| Rate for Payer: BCBS Complete |
$179.90
|
| Rate for Payer: Cash Price |
$359.81
|
| Rate for Payer: Cofinity Commercial |
$314.83
|
| Rate for Payer: Cofinity Commercial |
$386.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.81
|
| Rate for Payer: Healthscope Commercial |
$404.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.30
|
| Rate for Payer: PHP Commercial |
$382.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.34
|
| Rate for Payer: Priority Health SBD |
$283.35
|
| Rate for Payer: UMR Bronson Commercial |
$166.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.32
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 50268071011
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna American Axle |
$2.00
|
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.00
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.16
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.94
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$449.76
|
|
|
Service Code
|
NDC 00904678061
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.89 |
| Max. Negotiated Rate |
$404.78 |
| Rate for Payer: Aetna American Axle |
$292.34
|
| Rate for Payer: Aetna Commercial |
$382.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.34
|
| Rate for Payer: Cash Price |
$359.81
|
| Rate for Payer: Cofinity Commercial |
$314.83
|
| Rate for Payer: Cofinity Commercial |
$386.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$314.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.81
|
| Rate for Payer: Healthscope Commercial |
$404.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.30
|
| Rate for Payer: PHP Commercial |
$382.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.34
|
| Rate for Payer: Priority Health SBD |
$283.35
|
| Rate for Payer: UMR Bronson Commercial |
$197.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.32
|
|
|
ROSUVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 00781540292
|
| Hospital Charge Code |
35135
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$179.76
|
|
|
Service Code
|
NDC 50268071115
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.09 |
| Max. Negotiated Rate |
$161.78 |
| Rate for Payer: Aetna American Axle |
$116.84
|
| Rate for Payer: Aetna Commercial |
$152.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.84
|
| Rate for Payer: Cash Price |
$143.81
|
| Rate for Payer: Cofinity Commercial |
$125.83
|
| Rate for Payer: Cofinity Commercial |
$154.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.81
|
| Rate for Payer: Healthscope Commercial |
$161.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.80
|
| Rate for Payer: PHP Commercial |
$152.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.84
|
| Rate for Payer: Priority Health SBD |
$113.25
|
| Rate for Payer: UMR Bronson Commercial |
$79.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.82
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 50268071111
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$179.76
|
|
|
Service Code
|
NDC 50268071115
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.51 |
| Max. Negotiated Rate |
$161.78 |
| Rate for Payer: Aetna American Axle |
$116.84
|
| Rate for Payer: Aetna Commercial |
$152.80
|
| Rate for Payer: Aetna Medicare |
$89.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.84
|
| Rate for Payer: BCBS Complete |
$71.90
|
| Rate for Payer: Cash Price |
$143.81
|
| Rate for Payer: Cofinity Commercial |
$125.83
|
| Rate for Payer: Cofinity Commercial |
$154.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.81
|
| Rate for Payer: Healthscope Commercial |
$161.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.80
|
| Rate for Payer: PHP Commercial |
$152.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.84
|
| Rate for Payer: Priority Health SBD |
$113.25
|
| Rate for Payer: UMR Bronson Commercial |
$66.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.82
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$3.60
|
|
|
Service Code
|
NDC 50268071111
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna American Axle |
$2.34
|
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.34
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.27
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$573.60
|
|
|
Service Code
|
NDC 00904678161
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.23 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Aetna American Axle |
$372.84
|
| Rate for Payer: Aetna Commercial |
$487.56
|
| Rate for Payer: Aetna Medicare |
$286.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.84
|
| Rate for Payer: BCBS Complete |
$229.44
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Commercial |
$401.52
|
| Rate for Payer: Cofinity Commercial |
$493.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$401.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$516.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: PHP Commercial |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.84
|
| Rate for Payer: Priority Health SBD |
$361.37
|
| Rate for Payer: UMR Bronson Commercial |
$212.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.20
|
|
|
ROSUVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$573.60
|
|
|
Service Code
|
NDC 00904678161
|
| Hospital Charge Code |
35136
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.38 |
| Max. Negotiated Rate |
$516.24 |
| Rate for Payer: Aetna American Axle |
$372.84
|
| Rate for Payer: Aetna Commercial |
$487.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$372.84
|
| Rate for Payer: Cash Price |
$458.88
|
| Rate for Payer: Cofinity Commercial |
$401.52
|
| Rate for Payer: Cofinity Commercial |
$493.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$401.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.88
|
| Rate for Payer: Healthscope Commercial |
$516.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$401.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$430.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.56
|
| Rate for Payer: PHP Commercial |
$487.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.84
|
| Rate for Payer: Priority Health SBD |
$361.37
|
| Rate for Payer: UMR Bronson Commercial |
$252.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$430.20
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UMR Bronson Commercial |
$41.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$133.25
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$114.60
|
| Rate for Payer: Cofinity Commercial |
$93.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.61
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UMR Bronson Commercial |
$58.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 68462026190
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.32 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: UMR Bronson Commercial |
$49.32
|
| Rate for Payer: Aetna American Axle |
$72.86
|
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
ROSUVASTATIN 5 MG TABLET
|
Facility
|
OP
|
$133.25
|
|
|
Service Code
|
NDC 65862029390
|
| Hospital Charge Code |
36612
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: Aetna American Axle |
$86.61
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Medicare |
$66.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.61
|
| Rate for Payer: BCBS Complete |
$53.30
|
| Rate for Payer: Cash Price |
$106.60
|
| Rate for Payer: Cofinity Commercial |
$114.60
|
| Rate for Payer: Cofinity Commercial |
$93.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.60
|
| Rate for Payer: Healthscope Commercial |
$119.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.26
|
| Rate for Payer: PHP Commercial |
$113.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.61
|
| Rate for Payer: Priority Health SBD |
$83.95
|
| Rate for Payer: UMR Bronson Commercial |
$49.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.94
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION
|
Facility
|
IP
|
$292.99
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.92 |
| Max. Negotiated Rate |
$263.69 |
| Rate for Payer: Aetna American Axle |
$190.44
|
| Rate for Payer: Aetna Commercial |
$249.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.44
|
| Rate for Payer: Cash Price |
$234.39
|
| Rate for Payer: Cofinity Commercial |
$205.09
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.39
|
| Rate for Payer: Healthscope Commercial |
$263.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.04
|
| Rate for Payer: PHP Commercial |
$249.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.44
|
| Rate for Payer: Priority Health SBD |
$184.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.74
|
|
|
ROTAVIRUS VACCINE LIVE, PENTAVALENT 2 ML ORAL SOLUTION
|
Facility
|
OP
|
$292.99
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.01 |
| Max. Negotiated Rate |
$263.69 |
| Rate for Payer: Aetna American Axle |
$190.44
|
| Rate for Payer: Aetna Commercial |
$249.04
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.44
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS Trust/PPO |
$256.99
|
| Rate for Payer: BCN Commercial |
$256.99
|
| Rate for Payer: Cash Price |
$234.39
|
| Rate for Payer: Cash Price |
$234.39
|
| Rate for Payer: Cofinity Commercial |
$205.09
|
| Rate for Payer: Cofinity Commercial |
$251.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.39
|
| Rate for Payer: Healthscope Commercial |
$263.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.04
|
| Rate for Payer: PHP Commercial |
$249.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.51
|
| Rate for Payer: Priority Health Narrow Network |
$90.01
|
| Rate for Payer: Priority Health SBD |
$184.58
|
| Rate for Payer: UMR Bronson Commercial |
$108.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.74
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
IP
|
$5,450.55
|
|
|
Service Code
|
NDC 62856058252
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,398.24 |
| Max. Negotiated Rate |
$4,905.50 |
| Rate for Payer: Aetna American Axle |
$3,542.86
|
| Rate for Payer: Aetna Commercial |
$4,632.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.86
|
| Rate for Payer: Cash Price |
$4,360.44
|
| Rate for Payer: Cofinity Commercial |
$3,815.38
|
| Rate for Payer: Cofinity Commercial |
$4,687.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,815.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,360.44
|
| Rate for Payer: Healthscope Commercial |
$4,905.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,815.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,087.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,632.97
|
| Rate for Payer: PHP Commercial |
$4,632.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,542.86
|
| Rate for Payer: Priority Health SBD |
$3,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,398.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,087.91
|
|
|
RUFINAMIDE 200 MG TABLET
|
Facility
|
OP
|
$5,450.55
|
|
|
Service Code
|
NDC 62856058252
|
| Hospital Charge Code |
95691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,016.70 |
| Max. Negotiated Rate |
$4,905.50 |
| Rate for Payer: Aetna American Axle |
$3,542.86
|
| Rate for Payer: Aetna Commercial |
$4,632.97
|
| Rate for Payer: Aetna Medicare |
$2,725.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.86
|
| Rate for Payer: BCBS Complete |
$2,180.22
|
| Rate for Payer: Cash Price |
$4,360.44
|
| Rate for Payer: Cofinity Commercial |
$3,815.38
|
| Rate for Payer: Cofinity Commercial |
$4,687.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,815.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,360.44
|
| Rate for Payer: Healthscope Commercial |
$4,905.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,815.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,087.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,632.97
|
| Rate for Payer: PHP Commercial |
$4,632.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,542.86
|
| Rate for Payer: Priority Health SBD |
$3,433.85
|
| Rate for Payer: UMR Bronson Commercial |
$2,016.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,087.91
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$2,536.13
|
|
|
Service Code
|
NDC 00054042623
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$938.37 |
| Max. Negotiated Rate |
$2,282.52 |
| Rate for Payer: Aetna American Axle |
$1,648.48
|
| Rate for Payer: Aetna Commercial |
$2,155.71
|
| Rate for Payer: Aetna Medicare |
$1,268.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.48
|
| Rate for Payer: BCBS Complete |
$1,014.45
|
| Rate for Payer: Cash Price |
$2,028.90
|
| Rate for Payer: Cofinity Commercial |
$1,775.29
|
| Rate for Payer: Cofinity Commercial |
$2,181.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,775.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.90
|
| Rate for Payer: Healthscope Commercial |
$2,282.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,155.71
|
| Rate for Payer: PHP Commercial |
$2,155.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.48
|
| Rate for Payer: Priority Health SBD |
$1,597.76
|
| Rate for Payer: UMR Bronson Commercial |
$938.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.10
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$1,617.05
|
|
|
Service Code
|
NDC 59651061708
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$598.31 |
| Max. Negotiated Rate |
$1,455.34 |
| Rate for Payer: Aetna American Axle |
$1,051.08
|
| Rate for Payer: Aetna Commercial |
$1,374.49
|
| Rate for Payer: Aetna Medicare |
$808.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.08
|
| Rate for Payer: BCBS Complete |
$646.82
|
| Rate for Payer: Cash Price |
$1,293.64
|
| Rate for Payer: Cofinity Commercial |
$1,131.94
|
| Rate for Payer: Cofinity Commercial |
$1,390.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,131.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,293.64
|
| Rate for Payer: Healthscope Commercial |
$1,455.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,131.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,212.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,374.49
|
| Rate for Payer: PHP Commercial |
$1,374.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.08
|
| Rate for Payer: Priority Health SBD |
$1,018.74
|
| Rate for Payer: UMR Bronson Commercial |
$598.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,212.79
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
OP
|
$10,901.09
|
|
|
Service Code
|
NDC 62856058352
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,033.40 |
| Max. Negotiated Rate |
$9,810.98 |
| Rate for Payer: Aetna American Axle |
$7,085.71
|
| Rate for Payer: Aetna Commercial |
$9,265.93
|
| Rate for Payer: Aetna Medicare |
$5,450.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,085.71
|
| Rate for Payer: BCBS Complete |
$4,360.44
|
| Rate for Payer: Cash Price |
$8,720.87
|
| Rate for Payer: Cofinity Commercial |
$7,630.76
|
| Rate for Payer: Cofinity Commercial |
$9,374.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,630.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,720.87
|
| Rate for Payer: Healthscope Commercial |
$9,810.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,630.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,175.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,265.93
|
| Rate for Payer: PHP Commercial |
$9,265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,085.71
|
| Rate for Payer: Priority Health SBD |
$6,867.69
|
| Rate for Payer: UMR Bronson Commercial |
$4,033.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,175.82
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$10,901.09
|
|
|
Service Code
|
NDC 62856058352
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,796.48 |
| Max. Negotiated Rate |
$9,810.98 |
| Rate for Payer: Aetna American Axle |
$7,085.71
|
| Rate for Payer: Aetna Commercial |
$9,265.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,085.71
|
| Rate for Payer: Cash Price |
$8,720.87
|
| Rate for Payer: Cofinity Commercial |
$7,630.76
|
| Rate for Payer: Cofinity Commercial |
$9,374.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$7,630.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,720.87
|
| Rate for Payer: Healthscope Commercial |
$9,810.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,630.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,175.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,265.93
|
| Rate for Payer: PHP Commercial |
$9,265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,085.71
|
| Rate for Payer: Priority Health SBD |
$6,867.69
|
| Rate for Payer: UMR Bronson Commercial |
$4,796.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,175.82
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$1,617.05
|
|
|
Service Code
|
NDC 59651061708
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$711.50 |
| Max. Negotiated Rate |
$1,455.34 |
| Rate for Payer: Aetna American Axle |
$1,051.08
|
| Rate for Payer: Aetna Commercial |
$1,374.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.08
|
| Rate for Payer: Cash Price |
$1,293.64
|
| Rate for Payer: Cofinity Commercial |
$1,131.94
|
| Rate for Payer: Cofinity Commercial |
$1,390.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,131.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,293.64
|
| Rate for Payer: Healthscope Commercial |
$1,455.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,131.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,212.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,374.49
|
| Rate for Payer: PHP Commercial |
$1,374.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.08
|
| Rate for Payer: Priority Health SBD |
$1,018.74
|
| Rate for Payer: UMR Bronson Commercial |
$711.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,212.79
|
|
|
RUFINAMIDE 400 MG TABLET
|
Facility
|
IP
|
$2,536.13
|
|
|
Service Code
|
NDC 00054042623
|
| Hospital Charge Code |
95692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,115.90 |
| Max. Negotiated Rate |
$2,282.52 |
| Rate for Payer: Aetna American Axle |
$1,648.48
|
| Rate for Payer: Aetna Commercial |
$2,155.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.48
|
| Rate for Payer: Cash Price |
$2,028.90
|
| Rate for Payer: Cofinity Commercial |
$1,775.29
|
| Rate for Payer: Cofinity Commercial |
$2,181.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,775.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,028.90
|
| Rate for Payer: Healthscope Commercial |
$2,282.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,775.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,902.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,155.71
|
| Rate for Payer: PHP Commercial |
$2,155.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,648.48
|
| Rate for Payer: Priority Health SBD |
$1,597.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,115.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,902.10
|
|
