|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
IP
|
$1,018.30
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$661.89 |
| Max. Negotiated Rate |
$1,018.30 |
| Rate for Payer: Aetna Commercial |
$916.47
|
| Rate for Payer: Aetna Commercial |
$1,091.64
|
| Rate for Payer: ASR ASR |
$1,176.54
|
| Rate for Payer: ASR ASR |
$987.75
|
| Rate for Payer: ASR Commercial |
$1,176.54
|
| Rate for Payer: ASR Commercial |
$987.75
|
| Rate for Payer: BCBS Trust/PPO |
$988.42
|
| Rate for Payer: BCBS Trust/PPO |
$829.81
|
| Rate for Payer: BCN Commercial |
$940.38
|
| Rate for Payer: BCN Commercial |
$789.49
|
| Rate for Payer: Cash Price |
$814.64
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cofinity Commercial |
$1,140.15
|
| Rate for Payer: Cofinity Commercial |
$957.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Healthscope Commercial |
$1,018.30
|
| Rate for Payer: Healthscope Commercial |
$1,212.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.54
|
| Rate for Payer: Healthscope Whirlpool |
$987.75
|
| Rate for Payer: Mclaren Commercial |
$916.47
|
| Rate for Payer: Mclaren Commercial |
$1,091.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.55
|
| Rate for Payer: Nomi Health Commercial |
$994.60
|
| Rate for Payer: Nomi Health Commercial |
$835.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$896.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.38
|
|
|
RABIES VACCINE, PURIFIED CHICKEN EMBRYO CELL (PF) 2.5 UNIT IM SUSP
|
Facility
|
OP
|
$1,212.93
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$1,212.93 |
| Rate for Payer: Aetna Commercial |
$1,091.64
|
| Rate for Payer: Aetna Commercial |
$916.47
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: Aetna Medicare |
$313.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392.10
|
| Rate for Payer: ASR ASR |
$1,176.54
|
| Rate for Payer: ASR ASR |
$987.75
|
| Rate for Payer: ASR Commercial |
$987.75
|
| Rate for Payer: ASR Commercial |
$1,176.54
|
| Rate for Payer: BCBS Complete |
$176.54
|
| Rate for Payer: BCBS Complete |
$176.54
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCBS Trust/PPO |
$833.89
|
| Rate for Payer: BCBS Trust/PPO |
$993.27
|
| Rate for Payer: BCN Commercial |
$789.49
|
| Rate for Payer: BCN Commercial |
$940.38
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$970.34
|
| Rate for Payer: Cash Price |
$814.64
|
| Rate for Payer: Cash Price |
$814.64
|
| Rate for Payer: Cofinity Commercial |
$1,140.15
|
| Rate for Payer: Cofinity Commercial |
$957.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$970.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$814.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Healthscope Commercial |
$1,212.93
|
| Rate for Payer: Healthscope Commercial |
$1,018.30
|
| Rate for Payer: Healthscope Whirlpool |
$987.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,176.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$313.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$313.68
|
| Rate for Payer: Mclaren Commercial |
$916.47
|
| Rate for Payer: Mclaren Commercial |
$1,091.64
|
| Rate for Payer: Mclaren Medicaid |
$168.13
|
| Rate for Payer: Mclaren Medicaid |
$168.13
|
| Rate for Payer: Mclaren Medicare |
$313.68
|
| Rate for Payer: Mclaren Medicare |
$313.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Meridian Medicaid |
$176.54
|
| Rate for Payer: Meridian Medicaid |
$176.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,030.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$865.55
|
| Rate for Payer: Nomi Health Commercial |
$835.01
|
| Rate for Payer: Nomi Health Commercial |
$994.60
|
| Rate for Payer: PACE Medicare |
$298.00
|
| Rate for Payer: PACE Medicare |
$298.00
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PHP Commercial |
$345.05
|
| Rate for Payer: PHP Commercial |
$345.05
|
| Rate for Payer: PHP Medicaid |
$168.13
|
| Rate for Payer: PHP Medicaid |
$168.13
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$892.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,062.77
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: Priority Health Narrow Network |
$850.26
|
| Rate for Payer: Priority Health Narrow Network |
$713.83
|
| Rate for Payer: Railroad Medicare Medicare |
$313.68
|
| Rate for Payer: Railroad Medicare Medicare |
$313.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$896.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,067.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Exchange |
$486.20
|
| Rate for Payer: UHC Exchange |
$486.20
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
| Rate for Payer: UHCCP DNSP |
$313.68
|
| Rate for Payer: UHCCP DNSP |
$313.68
|
| Rate for Payer: UHCCP Medicaid |
$168.13
|
| Rate for Payer: UHCCP Medicaid |
$168.13
|
| Rate for Payer: VA VA |
$313.68
|
| Rate for Payer: VA VA |
$313.68
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.34 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: ASR ASR |
$6.48
|
| Rate for Payer: ASR Commercial |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$5.44
|
| Rate for Payer: BCN Commercial |
$5.18
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.68
|
| Rate for Payer: Healthscope Whirlpool |
$6.48
|
| 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: Priority Health Cigna Priority Health |
$4.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.88
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.88
|
| 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 |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| 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: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: 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 |
$3.26
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 00487278401
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.88
|
| 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 |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| 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: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
OP
|
$6.68
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: Aetna Medicare |
$3.34
|
| Rate for Payer: ASR ASR |
$6.48
|
| Rate for Payer: ASR Commercial |
$6.48
|
| Rate for Payer: BCBS Complete |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$5.47
|
| Rate for Payer: BCN Commercial |
$5.18
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.68
|
| Rate for Payer: Healthscope Whirlpool |
$6.48
|
| 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: Priority Health Cigna Priority Health |
$4.34
|
| Rate for Payer: 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
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
OP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,881.38 |
| Max. Negotiated Rate |
$7,203.46 |
| Rate for Payer: Aetna Commercial |
$6,483.11
|
| Rate for Payer: Aetna Medicare |
$3,601.73
|
| Rate for Payer: ASR ASR |
$6,987.36
|
| Rate for Payer: ASR Commercial |
$6,987.36
|
| Rate for Payer: BCBS Complete |
$2,881.38
|
| Rate for Payer: BCBS Trust/PPO |
$5,898.91
|
| Rate for Payer: BCN Commercial |
$5,584.84
|
| Rate for Payer: Cash Price |
$5,762.76
|
| Rate for Payer: Cofinity Commercial |
$6,771.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$7,203.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,987.36
|
| Rate for Payer: Mclaren Commercial |
$6,483.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: Nomi Health Commercial |
$5,906.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,311.67
|
| Rate for Payer: Priority Health Narrow Network |
$5,049.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,339.04
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 00006022761
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,682.25 |
| Max. Negotiated Rate |
$7,203.46 |
| Rate for Payer: Aetna Commercial |
$6,483.11
|
| Rate for Payer: ASR ASR |
$6,987.36
|
| Rate for Payer: ASR Commercial |
$6,987.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,870.10
|
| Rate for Payer: BCN Commercial |
$5,584.84
|
| Rate for Payer: Cash Price |
$5,762.76
|
| Rate for Payer: Cofinity Commercial |
$6,771.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$7,203.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,987.36
|
| Rate for Payer: Mclaren Commercial |
$6,483.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,122.94
|
| Rate for Payer: Nomi Health Commercial |
$5,906.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,682.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,339.04
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.71 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: ASR ASR |
$106.00
|
| Rate for Payer: ASR Commercial |
$106.00
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: BCBS Trust/PPO |
$89.49
|
| Rate for Payer: BCN Commercial |
$84.72
|
| 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 |
$109.28
|
| Rate for Payer: Healthscope Whirlpool |
$106.00
|
| Rate for Payer: Mclaren Commercial |
$98.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.75
|
| Rate for Payer: Priority Health Narrow Network |
$76.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.17
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 65862047401
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: ASR Commercial |
$168.68
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: BCBS Trust/PPO |
$142.41
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$173.90
|
| Rate for Payer: Healthscope Whirlpool |
$168.68
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.37
|
| Rate for Payer: Priority Health Narrow Network |
$121.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 65862047401
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: ASR Commercial |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$141.71
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$173.90
|
| Rate for Payer: Healthscope Whirlpool |
$168.68
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$109.28
|
|
|
Service Code
|
NDC 57237022230
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.03 |
| Max. Negotiated Rate |
$109.28 |
| Rate for Payer: Aetna Commercial |
$98.35
|
| Rate for Payer: ASR ASR |
$106.00
|
| Rate for Payer: ASR Commercial |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$89.05
|
| Rate for Payer: BCN Commercial |
$84.72
|
| 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 |
$109.28
|
| Rate for Payer: Healthscope Whirlpool |
$106.00
|
| Rate for Payer: Mclaren Commercial |
$98.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Nomi Health Commercial |
$89.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.17
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
OP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$108.10 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: ASR ASR |
$104.86
|
| Rate for Payer: ASR Commercial |
$104.86
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: BCBS Trust/PPO |
$88.52
|
| Rate for Payer: BCN Commercial |
$83.81
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$101.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$108.10
|
| Rate for Payer: Healthscope Whirlpool |
$104.86
|
| Rate for Payer: Mclaren Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.72
|
| Rate for Payer: Priority Health Narrow Network |
$75.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.13
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$108.10 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: ASR ASR |
$104.86
|
| Rate for Payer: ASR Commercial |
$104.86
|
| Rate for Payer: BCBS Trust/PPO |
$88.09
|
| Rate for Payer: BCN Commercial |
$83.81
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$101.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$108.10
|
| Rate for Payer: Healthscope Whirlpool |
$104.86
|
| Rate for Payer: Mclaren Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.13
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
NDC 65862047601
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.13 |
| Max. Negotiated Rate |
$177.12 |
| Rate for Payer: Aetna Commercial |
$159.41
|
| Rate for Payer: ASR ASR |
$171.81
|
| Rate for Payer: ASR Commercial |
$171.81
|
| Rate for Payer: BCBS Trust/PPO |
$144.34
|
| Rate for Payer: BCN Commercial |
$137.32
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$166.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$177.12
|
| Rate for Payer: Healthscope Whirlpool |
$171.81
|
| Rate for Payer: Mclaren Commercial |
$159.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.87
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.90
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: ASR ASR |
$5.72
|
| Rate for Payer: ASR Commercial |
$5.72
|
| Rate for Payer: BCBS Trust/PPO |
$4.81
|
| Rate for Payer: BCN Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cofinity Commercial |
$5.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.72
|
| Rate for Payer: Healthscope Commercial |
$5.90
|
| Rate for Payer: Healthscope Whirlpool |
$5.72
|
| Rate for Payer: Mclaren Commercial |
$5.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.01
|
| Rate for Payer: Nomi Health Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.19
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 60687054921
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.85 |
| Max. Negotiated Rate |
$177.12 |
| Rate for Payer: Aetna Commercial |
$159.41
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: ASR ASR |
$171.81
|
| Rate for Payer: ASR Commercial |
$171.81
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: BCBS Trust/PPO |
$145.04
|
| Rate for Payer: BCN Commercial |
$137.32
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$166.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$177.12
|
| Rate for Payer: Healthscope Whirlpool |
$171.81
|
| Rate for Payer: Mclaren Commercial |
$159.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Nomi Health Commercial |
$145.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.19
|
| Rate for Payer: Priority Health Narrow Network |
$124.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$155.87
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
OP
|
$5.90
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.90 |
| Rate for Payer: Aetna Commercial |
$5.31
|
| Rate for Payer: Aetna Medicare |
$2.95
|
| Rate for Payer: ASR ASR |
$5.72
|
| Rate for Payer: ASR Commercial |
$5.72
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$4.83
|
| Rate for Payer: BCN Commercial |
$4.57
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cofinity Commercial |
$5.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.72
|
| Rate for Payer: Healthscope Commercial |
$5.90
|
| Rate for Payer: Healthscope Whirlpool |
$5.72
|
| Rate for Payer: Mclaren Commercial |
$5.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.01
|
| Rate for Payer: Nomi Health Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.17
|
| Rate for Payer: Priority Health Narrow Network |
$4.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.19
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$30.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Commercial |
$53.64
|
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Commercial |
$30.20
|
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: ASR ASR |
$930.11
|
| Rate for Payer: ASR ASR |
$57.81
|
| Rate for Payer: ASR ASR |
$32.55
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: ASR ASR |
$28.87
|
| Rate for Payer: ASR Commercial |
$32.55
|
| Rate for Payer: ASR Commercial |
$930.11
|
| Rate for Payer: ASR Commercial |
$57.81
|
| Rate for Payer: ASR Commercial |
$29.88
|
| Rate for Payer: ASR Commercial |
$28.87
|
| Rate for Payer: BCBS Trust/PPO |
$781.39
|
| Rate for Payer: BCBS Trust/PPO |
$24.25
|
| Rate for Payer: BCBS Trust/PPO |
$25.10
|
| Rate for Payer: BCBS Trust/PPO |
$48.57
|
| Rate for Payer: BCBS Trust/PPO |
$27.35
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: BCN Commercial |
$743.42
|
| Rate for Payer: BCN Commercial |
$23.07
|
| Rate for Payer: BCN Commercial |
$26.02
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$31.55
|
| Rate for Payer: Cofinity Commercial |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Cofinity Commercial |
$901.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.64
|
| Rate for Payer: Healthscope Commercial |
$33.56
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$29.76
|
| Rate for Payer: Healthscope Commercial |
$958.88
|
| Rate for Payer: Healthscope Whirlpool |
$930.11
|
| Rate for Payer: Healthscope Whirlpool |
$28.87
|
| Rate for Payer: Healthscope Whirlpool |
$32.55
|
| Rate for Payer: Healthscope Whirlpool |
$29.88
|
| Rate for Payer: Healthscope Whirlpool |
$57.81
|
| Rate for Payer: Mclaren Commercial |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$30.20
|
| Rate for Payer: Mclaren Commercial |
$26.78
|
| Rate for Payer: Mclaren Commercial |
$53.64
|
| Rate for Payer: Mclaren Commercial |
$862.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$25.26
|
| Rate for Payer: Nomi Health Commercial |
$786.28
|
| Rate for Payer: Nomi Health Commercial |
$48.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.45
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$29.76
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$29.76 |
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna Commercial |
$53.64
|
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Commercial |
$30.20
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Aetna Medicare |
$479.44
|
| Rate for Payer: Aetna Medicare |
$29.80
|
| Rate for Payer: ASR ASR |
$930.11
|
| Rate for Payer: ASR ASR |
$32.55
|
| Rate for Payer: ASR ASR |
$28.87
|
| Rate for Payer: ASR ASR |
$57.81
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: ASR Commercial |
$930.11
|
| Rate for Payer: ASR Commercial |
$29.88
|
| Rate for Payer: ASR Commercial |
$32.55
|
| Rate for Payer: ASR Commercial |
$57.81
|
| Rate for Payer: ASR Commercial |
$28.87
|
| Rate for Payer: BCBS Complete |
$383.55
|
| Rate for Payer: BCBS Complete |
$12.32
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Complete |
$23.84
|
| Rate for Payer: BCBS Complete |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$48.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$25.22
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCBS Trust/PPO |
$785.23
|
| Rate for Payer: BCN Commercial |
$743.42
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: BCN Commercial |
$23.07
|
| Rate for Payer: BCN Commercial |
$26.02
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$901.35
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Cofinity Commercial |
$31.55
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$27.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Healthscope Commercial |
$33.56
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$958.88
|
| Rate for Payer: Healthscope Commercial |
$29.76
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Whirlpool |
$57.81
|
| Rate for Payer: Healthscope Whirlpool |
$32.55
|
| Rate for Payer: Healthscope Whirlpool |
$29.88
|
| Rate for Payer: Healthscope Whirlpool |
$28.87
|
| Rate for Payer: Healthscope Whirlpool |
$930.11
|
| Rate for Payer: Mclaren Commercial |
$862.99
|
| Rate for Payer: Mclaren Commercial |
$30.20
|
| Rate for Payer: Mclaren Commercial |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$53.64
|
| Rate for Payer: Mclaren Commercial |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.05
|
| Rate for Payer: Nomi Health Commercial |
$48.87
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: Nomi Health Commercial |
$24.40
|
| Rate for Payer: Nomi Health Commercial |
$25.26
|
| Rate for Payer: Nomi Health Commercial |
$786.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$840.17
|
| Rate for Payer: Priority Health Narrow Network |
$672.17
|
| Rate for Payer: Priority Health Narrow Network |
$41.78
|
| Rate for Payer: Priority Health Narrow Network |
$21.59
|
| Rate for Payer: Priority Health Narrow Network |
$20.86
|
| Rate for Payer: Priority Health Narrow Network |
$23.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$843.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.53
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
OP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$2,031.52 |
| Rate for Payer: Aetna Commercial |
$1,828.37
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.41
|
| Rate for Payer: ASR ASR |
$1,970.57
|
| Rate for Payer: ASR Commercial |
$1,970.57
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS MAPPO |
$6.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.61
|
| Rate for Payer: BCN Commercial |
$1,575.04
|
| Rate for Payer: BCN Medicare Advantage |
$6.73
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,909.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.73
|
| Rate for Payer: Healthscope Commercial |
$2,031.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,970.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.73
|
| Rate for Payer: Mclaren Commercial |
$1,828.37
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicare |
$6.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.07
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: Nomi Health Commercial |
$1,665.85
|
| Rate for Payer: PACE Medicare |
$6.39
|
| Rate for Payer: PACE SWMI |
$6.73
|
| Rate for Payer: PHP Commercial |
$7.40
|
| Rate for Payer: PHP Medicaid |
$3.61
|
| Rate for Payer: PHP Medicare Advantage |
$6.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,780.02
|
| Rate for Payer: Priority Health Medicare |
$6.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,787.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.73
|
| Rate for Payer: UHC Exchange |
$10.43
|
| Rate for Payer: UHC Medicare Advantage |
$6.73
|
| Rate for Payer: UHCCP DNSP |
$6.73
|
| Rate for Payer: UHCCP Medicaid |
$3.61
|
| Rate for Payer: VA VA |
$6.73
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$2,031.52
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,320.49 |
| Max. Negotiated Rate |
$2,031.52 |
| Rate for Payer: Aetna Commercial |
$1,828.37
|
| Rate for Payer: ASR ASR |
$1,970.57
|
| Rate for Payer: ASR Commercial |
$1,970.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.49
|
| Rate for Payer: BCN Commercial |
$1,575.04
|
| Rate for Payer: Cash Price |
$1,625.22
|
| Rate for Payer: Cofinity Commercial |
$1,909.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.22
|
| Rate for Payer: Healthscope Commercial |
$2,031.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,970.57
|
| Rate for Payer: Mclaren Commercial |
$1,828.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.79
|
| Rate for Payer: Nomi Health Commercial |
$1,665.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,787.74
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 43900035988
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: ASR ASR |
$3.75
|
| Rate for Payer: ASR Commercial |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Healthscope Whirlpool |
$3.75
|
| Rate for Payer: Mclaren Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
