|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$2,850.96
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,850.96 |
| Rate for Payer: Aetna Commercial |
$2,565.86
|
| Rate for Payer: Aetna Commercial |
$12,829.30
|
| Rate for Payer: Aetna Commercial |
$7,697.58
|
| Rate for Payer: Aetna Commercial |
$2,892.42
|
| Rate for Payer: Aetna Medicare |
$275.18
|
| Rate for Payer: Aetna Medicare |
$275.18
|
| Rate for Payer: Aetna Medicare |
$275.18
|
| Rate for Payer: Aetna Medicare |
$275.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$343.98
|
| Rate for Payer: ASR ASR |
$8,296.28
|
| Rate for Payer: ASR ASR |
$13,827.14
|
| Rate for Payer: ASR ASR |
$3,117.39
|
| Rate for Payer: ASR ASR |
$2,765.43
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS Complete |
$151.13
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS MAPPO |
$275.18
|
| Rate for Payer: BCBS Trust/PPO |
$11,753.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,649.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,350.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,051.84
|
| Rate for Payer: BCN Commercial |
$11,753.07
|
| Rate for Payer: BCN Commercial |
$2,350.62
|
| Rate for Payer: BCN Commercial |
$7,051.84
|
| Rate for Payer: BCN Commercial |
$2,649.78
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: BCN Medicare Advantage |
$275.18
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cash Price |
$6,842.30
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cash Price |
$6,842.30
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cofinity Commercial |
$13,399.49
|
| Rate for Payer: Cofinity Commercial |
$3,020.97
|
| Rate for Payer: Cofinity Commercial |
$8,039.70
|
| Rate for Payer: Cofinity Commercial |
$2,679.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,403.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,842.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,571.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,280.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.18
|
| Rate for Payer: Healthscope Commercial |
$13,827.14
|
| Rate for Payer: Healthscope Commercial |
$8,296.28
|
| Rate for Payer: Healthscope Commercial |
$2,765.43
|
| Rate for Payer: Healthscope Commercial |
$3,117.39
|
| Rate for Payer: Healthscope Whirlpool |
$8,552.87
|
| Rate for Payer: Healthscope Whirlpool |
$14,254.78
|
| Rate for Payer: Healthscope Whirlpool |
$3,213.80
|
| Rate for Payer: Healthscope Whirlpool |
$2,850.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$275.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$275.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$275.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$275.18
|
| Rate for Payer: Mclaren Commercial |
$7,697.58
|
| Rate for Payer: Mclaren Commercial |
$2,565.86
|
| Rate for Payer: Mclaren Commercial |
$12,829.30
|
| Rate for Payer: Mclaren Commercial |
$2,892.42
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicaid |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Mclaren Medicare |
$275.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.94
|
| Rate for Payer: Meridian Medicaid |
$151.13
|
| Rate for Payer: Meridian Medicaid |
$151.13
|
| Rate for Payer: Meridian Medicaid |
$151.13
|
| Rate for Payer: Meridian Medicaid |
$151.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$302.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,731.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,423.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,269.94
|
| Rate for Payer: Nomi Health Commercial |
$2,337.79
|
| Rate for Payer: Nomi Health Commercial |
$2,635.32
|
| Rate for Payer: Nomi Health Commercial |
$11,688.92
|
| Rate for Payer: Nomi Health Commercial |
$7,013.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,410.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,414.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,691.08
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE Medicare |
$261.42
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PACE SWMI |
$275.18
|
| Rate for Payer: PHP Commercial |
$302.70
|
| Rate for Payer: PHP Commercial |
$302.70
|
| Rate for Payer: PHP Commercial |
$302.70
|
| Rate for Payer: PHP Commercial |
$302.70
|
| Rate for Payer: PHP Medicaid |
$147.50
|
| Rate for Payer: PHP Medicaid |
$147.50
|
| Rate for Payer: PHP Medicaid |
$147.50
|
| Rate for Payer: PHP Medicaid |
$147.50
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: PHP Medicare Advantage |
$275.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$290.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$290.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$290.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$290.51
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Medicare |
$275.18
|
| Rate for Payer: Priority Health Narrow Network |
$232.41
|
| Rate for Payer: Priority Health Narrow Network |
$232.41
|
| Rate for Payer: Priority Health Narrow Network |
$232.41
|
| Rate for Payer: Priority Health Narrow Network |
$232.41
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: Railroad Medicare Medicare |
$275.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,828.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,508.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,544.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,526.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.18
|
| Rate for Payer: UHC Exchange |
$426.53
|
| Rate for Payer: UHC Exchange |
$426.53
|
| Rate for Payer: UHC Exchange |
$426.53
|
| Rate for Payer: UHC Exchange |
$426.53
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHC Medicaid |
$143.92
|
| Rate for Payer: UHCCP DNSP |
$275.18
|
| Rate for Payer: UHCCP DNSP |
$275.18
|
| Rate for Payer: UHCCP DNSP |
$275.18
|
| Rate for Payer: UHCCP DNSP |
$275.18
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: UHCCP Medicaid |
$143.92
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: VA VA |
$275.18
|
| Rate for Payer: VA VA |
$275.18
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNIT/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$3,213.80
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
186395
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,410.35 |
| Max. Negotiated Rate |
$3,213.80 |
| Rate for Payer: Aetna Commercial |
$2,892.42
|
| Rate for Payer: Aetna Commercial |
$2,565.86
|
| Rate for Payer: Aetna Commercial |
$7,697.58
|
| Rate for Payer: Aetna Commercial |
$12,829.30
|
| Rate for Payer: ASR ASR |
$8,296.28
|
| Rate for Payer: ASR ASR |
$3,117.39
|
| Rate for Payer: ASR ASR |
$2,765.43
|
| Rate for Payer: ASR ASR |
$13,827.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,639.17
|
| Rate for Payer: BCBS Trust/PPO |
$11,706.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,341.21
|
| Rate for Payer: BCBS Trust/PPO |
$7,023.62
|
| Rate for Payer: BCN Commercial |
$11,706.03
|
| Rate for Payer: BCN Commercial |
$7,023.62
|
| Rate for Payer: BCN Commercial |
$2,341.21
|
| Rate for Payer: BCN Commercial |
$2,639.17
|
| Rate for Payer: Cash Price |
$6,842.30
|
| Rate for Payer: Cash Price |
$2,280.77
|
| Rate for Payer: Cash Price |
$2,571.04
|
| Rate for Payer: Cash Price |
$11,403.82
|
| Rate for Payer: Cofinity Commercial |
$3,020.97
|
| Rate for Payer: Cofinity Commercial |
$13,399.49
|
| Rate for Payer: Cofinity Commercial |
$8,039.70
|
| Rate for Payer: Cofinity Commercial |
$2,679.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,571.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,842.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,280.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,403.82
|
| Rate for Payer: Healthscope Commercial |
$3,117.39
|
| Rate for Payer: Healthscope Commercial |
$13,827.14
|
| Rate for Payer: Healthscope Commercial |
$2,765.43
|
| Rate for Payer: Healthscope Commercial |
$8,296.28
|
| Rate for Payer: Healthscope Whirlpool |
$3,213.80
|
| Rate for Payer: Healthscope Whirlpool |
$8,552.87
|
| Rate for Payer: Healthscope Whirlpool |
$14,254.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,850.96
|
| Rate for Payer: Mclaren Commercial |
$12,829.30
|
| Rate for Payer: Mclaren Commercial |
$7,697.58
|
| Rate for Payer: Mclaren Commercial |
$2,565.86
|
| Rate for Payer: Mclaren Commercial |
$2,892.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,731.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,269.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,423.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,116.56
|
| Rate for Payer: Nomi Health Commercial |
$2,337.79
|
| Rate for Payer: Nomi Health Commercial |
$7,013.35
|
| Rate for Payer: Nomi Health Commercial |
$2,635.32
|
| Rate for Payer: Nomi Health Commercial |
$11,688.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,410.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,691.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,414.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,544.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,828.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,508.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7,526.53
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,890.12
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$1,890.12 |
| Rate for Payer: Aetna Commercial |
$1,701.11
|
| Rate for Payer: Aetna Medicare |
$315.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$394.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$394.02
|
| Rate for Payer: ASR ASR |
$1,833.42
|
| Rate for Payer: BCBS Complete |
$173.12
|
| Rate for Payer: BCBS MAPPO |
$315.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,558.40
|
| Rate for Payer: BCN Commercial |
$1,558.40
|
| Rate for Payer: BCN Medicare Advantage |
$315.22
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cofinity Commercial |
$1,776.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.22
|
| Rate for Payer: Healthscope Commercial |
$1,833.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,890.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$315.22
|
| Rate for Payer: Mclaren Commercial |
$1,701.11
|
| Rate for Payer: Mclaren Medicaid |
$315.22
|
| Rate for Payer: Mclaren Medicare |
$315.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.98
|
| Rate for Payer: Meridian Medicaid |
$173.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$346.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,606.60
|
| Rate for Payer: Nomi Health Commercial |
$1,549.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,417.59
|
| Rate for Payer: PACE Medicare |
$299.46
|
| Rate for Payer: PACE SWMI |
$315.22
|
| Rate for Payer: PHP Commercial |
$346.74
|
| Rate for Payer: PHP Medicaid |
$168.96
|
| Rate for Payer: PHP Medicare Advantage |
$315.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$495.45
|
| Rate for Payer: Priority Health Medicare |
$315.22
|
| Rate for Payer: Priority Health Narrow Network |
$396.36
|
| Rate for Payer: Railroad Medicare Medicare |
$315.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,663.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$315.22
|
| Rate for Payer: UHC Exchange |
$488.59
|
| Rate for Payer: UHC Medicaid |
$164.86
|
| Rate for Payer: UHCCP DNSP |
$315.22
|
| Rate for Payer: UHCCP Medicaid |
$164.86
|
| Rate for Payer: VA VA |
$315.22
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,890.12
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,417.59 |
| Max. Negotiated Rate |
$1,890.12 |
| Rate for Payer: Aetna Commercial |
$1,701.11
|
| Rate for Payer: ASR ASR |
$1,833.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,552.17
|
| Rate for Payer: BCN Commercial |
$1,552.17
|
| Rate for Payer: Cash Price |
$1,512.10
|
| Rate for Payer: Cofinity Commercial |
$1,776.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,512.10
|
| Rate for Payer: Healthscope Commercial |
$1,833.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,890.12
|
| Rate for Payer: Mclaren Commercial |
$1,701.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,606.60
|
| Rate for Payer: Nomi Health Commercial |
$1,549.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,417.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,663.31
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
NDC 487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: Aetna Medicare |
$2.47
|
| Rate for Payer: ASR ASR |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.51
|
| Rate for Payer: BCN Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Healthscope Whirlpool |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$6.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$5.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.85
|
| Rate for Payer: Priority Health Narrow Network |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.88
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Healthscope Whirlpool |
$3.71
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.27
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$3.06
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Healthscope Whirlpool |
$3.71
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Narrow Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.27
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
NDC 487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: ASR ASR |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$5.49
|
| Rate for Payer: BCN Commercial |
$5.49
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.35
|
| Rate for Payer: Healthscope Commercial |
$6.48
|
| Rate for Payer: Healthscope Whirlpool |
$6.68
|
| Rate for Payer: Mclaren Commercial |
$6.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.68
|
| Rate for Payer: Nomi Health Commercial |
$5.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.88
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$19,294.50
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$17,444.54 |
| Max. Negotiated Rate |
$19,294.50 |
| Rate for Payer: BCBS Complete |
$19,294.50
|
| Rate for Payer: Mclaren Medicaid |
$18,375.71
|
| Rate for Payer: Meridian Medicaid |
$19,294.50
|
| Rate for Payer: PHP Medicaid |
$17,444.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,375.71
|
| Rate for Payer: UHC Medicaid |
$18,375.71
|
| Rate for Payer: UHCCP Medicaid |
$18,375.71
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$11,037.96
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$9,979.64 |
| Max. Negotiated Rate |
$11,037.96 |
| Rate for Payer: BCBS Complete |
$11,037.96
|
| Rate for Payer: Mclaren Medicaid |
$10,512.34
|
| Rate for Payer: Meridian Medicaid |
$11,037.96
|
| Rate for Payer: PHP Medicaid |
$9,979.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,512.34
|
| Rate for Payer: UHC Medicaid |
$10,512.34
|
| Rate for Payer: UHCCP Medicaid |
$10,512.34
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$37,225.28
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$20,202.92 |
| Max. Negotiated Rate |
$37,225.28 |
| Rate for Payer: Aetna Medicare |
$21,266.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,582.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,582.79
|
| Rate for Payer: BCBS MAPPO |
$21,266.23
|
| Rate for Payer: BCN Medicare Advantage |
$21,266.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,266.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,266.23
|
| Rate for Payer: Mclaren Medicare |
$21,266.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,329.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,456.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,392.85
|
| Rate for Payer: PACE Medicare |
$20,202.92
|
| Rate for Payer: PACE SWMI |
$21,266.23
|
| Rate for Payer: PHP Commercial |
$23,392.85
|
| Rate for Payer: PHP Medicare Advantage |
$21,266.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37,225.28
|
| Rate for Payer: Priority Health Medicare |
$21,266.23
|
| Rate for Payer: Priority Health Narrow Network |
$29,780.22
|
| Rate for Payer: Railroad Medicare Medicare |
$21,266.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,266.23
|
| Rate for Payer: UHC Exchange |
$32,962.66
|
| Rate for Payer: UHCCP DNSP |
$21,266.23
|
| Rate for Payer: VA VA |
$21,266.23
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$14,622.64
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$13,220.62 |
| Max. Negotiated Rate |
$14,622.64 |
| Rate for Payer: BCBS Complete |
$14,622.64
|
| Rate for Payer: Mclaren Medicaid |
$13,926.33
|
| Rate for Payer: Meridian Medicaid |
$14,622.64
|
| Rate for Payer: PHP Medicaid |
$13,220.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,926.33
|
| Rate for Payer: UHC Medicaid |
$13,926.33
|
| Rate for Payer: UHCCP Medicaid |
$13,926.33
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$4,395.57
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$3,974.12 |
| Max. Negotiated Rate |
$4,395.57 |
| Rate for Payer: BCBS Complete |
$4,395.57
|
| Rate for Payer: Mclaren Medicaid |
$4,186.25
|
| Rate for Payer: Meridian Medicaid |
$4,395.57
|
| Rate for Payer: PHP Medicaid |
$3,974.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,186.25
|
| Rate for Payer: UHC Medicaid |
$4,186.25
|
| Rate for Payer: UHCCP Medicaid |
$4,186.25
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,688.30
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,766.23 |
| Max. Negotiated Rate |
$7,688.30 |
| Rate for Payer: Aetna Commercial |
$6,919.47
|
| Rate for Payer: ASR ASR |
$7,457.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,313.64
|
| Rate for Payer: BCN Commercial |
$6,313.64
|
| Rate for Payer: Cash Price |
$6,150.64
|
| Rate for Payer: Cofinity Commercial |
$7,227.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.64
|
| Rate for Payer: Healthscope Commercial |
$7,457.65
|
| Rate for Payer: Healthscope Whirlpool |
$7,688.30
|
| Rate for Payer: Mclaren Commercial |
$6,919.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Nomi Health Commercial |
$6,304.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,765.71
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,688.30
|
|
|
Service Code
|
NDC 6022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,844.67 |
| Max. Negotiated Rate |
$7,688.30 |
| Rate for Payer: Aetna Commercial |
$6,919.47
|
| Rate for Payer: Aetna Medicare |
$2,844.67
|
| Rate for Payer: ASR ASR |
$7,457.65
|
| Rate for Payer: BCBS Complete |
$3,075.32
|
| Rate for Payer: BCBS Trust/PPO |
$6,339.01
|
| Rate for Payer: BCN Commercial |
$6,339.01
|
| Rate for Payer: Cash Price |
$6,150.64
|
| Rate for Payer: Cofinity Commercial |
$7,227.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,150.64
|
| Rate for Payer: Healthscope Commercial |
$7,457.65
|
| Rate for Payer: Healthscope Whirlpool |
$7,688.30
|
| Rate for Payer: Mclaren Commercial |
$6,919.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,150.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,535.06
|
| Rate for Payer: Nomi Health Commercial |
$6,304.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,766.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6,736.49
|
| Rate for Payer: Priority Health Narrow Network |
$5,389.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,765.71
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.96 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: ASR ASR |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.74
|
| Rate for Payer: BCN Commercial |
$89.74
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.28
|
| Rate for Payer: Mclaren Commercial |
$98.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.88
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.16
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna Medicare |
$40.43
|
| Rate for Payer: ASR ASR |
$106.00
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: BCBS Trust/PPO |
$90.10
|
| Rate for Payer: BCN Commercial |
$90.10
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Commercial |
$102.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Whirlpool |
$109.28
|
| Rate for Payer: Mclaren Commercial |
$98.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.88
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.75
|
| Rate for Payer: Priority Health Narrow Network |
$76.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.16
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$176.25
|
|
|
Service Code
|
NDC 65862047401
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Aetna Medicare |
$65.21
|
| Rate for Payer: ASR ASR |
$170.96
|
| Rate for Payer: BCBS Complete |
$70.50
|
| Rate for Payer: BCBS Trust/PPO |
$145.32
|
| Rate for Payer: BCN Commercial |
$145.32
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$165.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$170.96
|
| Rate for Payer: Healthscope Whirlpool |
$176.25
|
| Rate for Payer: Mclaren Commercial |
$158.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$144.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$154.43
|
| Rate for Payer: Priority Health Narrow Network |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.10
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$176.25
|
|
|
Service Code
|
NDC 65862047401
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.19 |
| Max. Negotiated Rate |
$176.25 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: ASR ASR |
$170.96
|
| Rate for Payer: BCBS Trust/PPO |
$144.74
|
| Rate for Payer: BCN Commercial |
$144.74
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cofinity Commercial |
$165.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.00
|
| Rate for Payer: Healthscope Commercial |
$170.96
|
| Rate for Payer: Healthscope Whirlpool |
$176.25
|
| Rate for Payer: Mclaren Commercial |
$158.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.81
|
| Rate for Payer: Nomi Health Commercial |
$144.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.10
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$110.45 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: Aetna Medicare |
$40.87
|
| Rate for Payer: ASR ASR |
$107.14
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: BCBS Trust/PPO |
$91.07
|
| Rate for Payer: BCN Commercial |
$91.07
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$107.14
|
| Rate for Payer: Healthscope Whirlpool |
$110.45
|
| Rate for Payer: Mclaren Commercial |
$99.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.78
|
| Rate for Payer: Priority Health Narrow Network |
$77.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.20
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.84 |
| Max. Negotiated Rate |
$110.45 |
| Rate for Payer: Aetna Commercial |
$99.41
|
| Rate for Payer: ASR ASR |
$107.14
|
| Rate for Payer: BCBS Trust/PPO |
$90.70
|
| Rate for Payer: BCN Commercial |
$90.70
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$107.14
|
| Rate for Payer: Healthscope Whirlpool |
$110.45
|
| Rate for Payer: Mclaren Commercial |
$99.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$90.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.20
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$143.35
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.51 |
| Max. Negotiated Rate |
$143.35 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: ASR ASR |
$139.05
|
| Rate for Payer: BCBS Trust/PPO |
$117.72
|
| Rate for Payer: BCN Commercial |
$117.72
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$134.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$139.05
|
| Rate for Payer: Healthscope Whirlpool |
$143.35
|
| Rate for Payer: Mclaren Commercial |
$129.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.15
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
OP
|
$143.35
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$143.35 |
| Rate for Payer: Aetna Commercial |
$129.01
|
| Rate for Payer: Aetna Medicare |
$53.04
|
| Rate for Payer: ASR ASR |
$139.05
|
| Rate for Payer: BCBS Complete |
$57.34
|
| Rate for Payer: BCBS Trust/PPO |
$118.19
|
| Rate for Payer: BCN Commercial |
$118.19
|
| Rate for Payer: Cash Price |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$134.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.68
|
| Rate for Payer: Healthscope Commercial |
$139.05
|
| Rate for Payer: Healthscope Whirlpool |
$143.35
|
| Rate for Payer: Mclaren Commercial |
$129.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.85
|
| Rate for Payer: Nomi Health Commercial |
$117.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$125.60
|
| Rate for Payer: Priority Health Narrow Network |
$100.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.15
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$5.89
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$5.88 |
| Rate for Payer: Aetna Commercial |
$5.30
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: ASR ASR |
$5.71
|
| Rate for Payer: BCBS Complete |
$2.35
|
| Rate for Payer: BCBS Trust/PPO |
$4.85
|
| Rate for Payer: BCN Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.71
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Healthscope Whirlpool |
$5.88
|
| Rate for Payer: Mclaren Commercial |
$5.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.16
|
| Rate for Payer: Priority Health Narrow Network |
$4.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.18
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$176.54
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.41 |
| Max. Negotiated Rate |
$176.54 |
| Rate for Payer: Aetna Commercial |
$158.89
|
| Rate for Payer: ASR ASR |
$171.25
|
| Rate for Payer: BCBS Trust/PPO |
$144.98
|
| Rate for Payer: BCN Commercial |
$144.98
|
| Rate for Payer: Cash Price |
$141.24
|
| Rate for Payer: Cofinity Commercial |
$165.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.24
|
| Rate for Payer: Healthscope Commercial |
$171.25
|
| Rate for Payer: Healthscope Whirlpool |
$176.54
|
| Rate for Payer: Mclaren Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.06
|
| Rate for Payer: Nomi Health Commercial |
$144.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.36
|
|
