|
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 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 |
$147.82
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| 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 |
$113.04 |
| 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 |
$147.82
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
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 2.5 MG CAPSULE
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 65862047501
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.26 |
| 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 |
$91.88
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.13
|
|
|
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 |
$91.88
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.26
|
| 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 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
|
$5.90
|
|
|
Service Code
|
NDC 60687054911
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.84 |
| 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 |
$5.02
|
| Rate for Payer: Nomi Health Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.19
|
|
|
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
|
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 |
$5.02
|
| Rate for Payer: Nomi Health Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| 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
|
|
|
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
|
|
|
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
|
$30.80
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Commercial |
$53.64
|
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Commercial |
$30.20
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: Aetna Medicare |
$14.88
|
| Rate for Payer: Aetna Medicare |
$15.40
|
| Rate for Payer: Aetna Medicare |
$29.80
|
| Rate for Payer: Aetna Medicare |
$479.44
|
| 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 ASR |
$32.55
|
| Rate for Payer: ASR ASR |
$930.11
|
| Rate for Payer: ASR Commercial |
$28.87
|
| Rate for Payer: ASR Commercial |
$29.88
|
| Rate for Payer: ASR Commercial |
$930.11
|
| Rate for Payer: ASR Commercial |
$57.81
|
| Rate for Payer: ASR Commercial |
$32.55
|
| Rate for Payer: BCBS Complete |
$383.55
|
| Rate for Payer: BCBS Complete |
$11.90
|
| 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 Trust/PPO |
$48.81
|
| Rate for Payer: BCBS Trust/PPO |
$27.48
|
| Rate for Payer: BCBS Trust/PPO |
$24.37
|
| Rate for Payer: BCBS Trust/PPO |
$25.22
|
| Rate for Payer: BCBS Trust/PPO |
$785.23
|
| Rate for Payer: BCN Commercial |
$46.21
|
| Rate for Payer: BCN Commercial |
$23.07
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: BCN Commercial |
$26.02
|
| Rate for Payer: BCN Commercial |
$743.42
|
| 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 |
$23.81
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$47.68
|
| Rate for Payer: Cash Price |
$23.81
|
| Rate for Payer: Cash Price |
$767.10
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Cofinity Commercial |
$56.02
|
| Rate for Payer: Cofinity Commercial |
$901.35
|
| Rate for Payer: Cofinity Commercial |
$27.97
|
| Rate for Payer: Cofinity Commercial |
$31.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$767.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Healthscope Commercial |
$59.60
|
| Rate for Payer: Healthscope Commercial |
$33.56
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$958.88
|
| Rate for Payer: Healthscope Commercial |
$29.76
|
| Rate for Payer: Healthscope Whirlpool |
$930.11
|
| Rate for Payer: Healthscope Whirlpool |
$29.88
|
| Rate for Payer: Healthscope Whirlpool |
$28.87
|
| Rate for Payer: Healthscope Whirlpool |
$57.81
|
| Rate for Payer: Healthscope Whirlpool |
$32.55
|
| Rate for Payer: Mclaren Commercial |
$53.64
|
| Rate for Payer: Mclaren Commercial |
$26.78
|
| Rate for Payer: Mclaren Commercial |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$30.20
|
| Rate for Payer: Mclaren Commercial |
$862.99
|
| 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 |
$26.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$815.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| 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: Nomi Health Commercial |
$27.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.74
|
| 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 |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$623.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.58
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: Priority Health Narrow Network |
$3.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.19
|
| 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 |
$843.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.53
|
|
|
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
|
|
|
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 |
$3.40 |
| Max. Negotiated Rate |
$2,031.52 |
| Rate for Payer: Aetna Commercial |
$1,828.37
|
| Rate for Payer: Aetna Medicare |
$6.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.94
|
| Rate for Payer: ASR ASR |
$1,970.57
|
| Rate for Payer: ASR Commercial |
$1,970.57
|
| Rate for Payer: BCBS Complete |
$3.57
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,663.61
|
| Rate for Payer: BCN Commercial |
$1,575.04
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| 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 |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$2,031.52
|
| Rate for Payer: Healthscope Whirlpool |
$1,970.57
|
| Rate for Payer: Humana Choice PPO Medicare |
$6.35
|
| Rate for Payer: Mclaren Commercial |
$1,828.37
|
| Rate for Payer: Mclaren Medicaid |
$3.40
|
| Rate for Payer: Mclaren Medicare |
$6.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.67
|
| Rate for Payer: Meridian Medicaid |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| 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 |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$6.98
|
| Rate for Payer: PHP Medicaid |
$3.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.59
|
| Rate for Payer: Priority Health Medicare |
$6.35
|
| Rate for Payer: Priority Health Narrow Network |
$5.27
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,787.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$9.84
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP DNSP |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$3.40
|
| Rate for Payer: VA VA |
$6.35
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 43900035984
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: ASR ASR |
$3.75
|
| Rate for Payer: ASR Commercial |
$3.75
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| 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: Priority Health HMO/PPO/Tiered Network |
$3.39
|
| Rate for Payer: Priority Health Narrow Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 43900035988
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: ASR ASR |
$3.75
|
| Rate for Payer: ASR Commercial |
$3.75
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| 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: Priority Health HMO/PPO/Tiered Network |
$3.39
|
| Rate for Payer: Priority Health Narrow Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
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
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 43900035984
|
| 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
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$287.29
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$186.74 |
| Max. Negotiated Rate |
$287.29 |
| Rate for Payer: Aetna Commercial |
$258.56
|
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Aetna Commercial |
$258.57
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: ASR ASR |
$278.67
|
| Rate for Payer: ASR ASR |
$278.68
|
| Rate for Payer: ASR Commercial |
$278.67
|
| Rate for Payer: ASR Commercial |
$228.30
|
| Rate for Payer: ASR Commercial |
$278.68
|
| Rate for Payer: BCBS Trust/PPO |
$234.12
|
| Rate for Payer: BCBS Trust/PPO |
$191.79
|
| Rate for Payer: BCBS Trust/PPO |
$234.11
|
| Rate for Payer: BCN Commercial |
$182.47
|
| Rate for Payer: BCN Commercial |
$222.74
|
| Rate for Payer: BCN Commercial |
$222.74
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Cofinity Commercial |
$270.06
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$270.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.84
|
| Rate for Payer: Healthscope Commercial |
$235.36
|
| Rate for Payer: Healthscope Commercial |
$287.29
|
| Rate for Payer: Healthscope Commercial |
$287.30
|
| Rate for Payer: Healthscope Whirlpool |
$278.67
|
| Rate for Payer: Healthscope Whirlpool |
$228.30
|
| Rate for Payer: Healthscope Whirlpool |
$278.68
|
| Rate for Payer: Mclaren Commercial |
$258.56
|
| Rate for Payer: Mclaren Commercial |
$211.82
|
| Rate for Payer: Mclaren Commercial |
$258.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Nomi Health Commercial |
$235.58
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$235.36
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$235.36 |
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Aetna Commercial |
$258.57
|
| Rate for Payer: Aetna Commercial |
$258.56
|
| Rate for Payer: Aetna Medicare |
$143.65
|
| Rate for Payer: Aetna Medicare |
$117.68
|
| Rate for Payer: Aetna Medicare |
$143.64
|
| Rate for Payer: ASR ASR |
$278.67
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: ASR ASR |
$278.68
|
| Rate for Payer: ASR Commercial |
$278.67
|
| Rate for Payer: ASR Commercial |
$228.30
|
| Rate for Payer: ASR Commercial |
$278.68
|
| Rate for Payer: BCBS Complete |
$94.14
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Complete |
$114.92
|
| Rate for Payer: BCBS Trust/PPO |
$235.27
|
| Rate for Payer: BCBS Trust/PPO |
$192.74
|
| Rate for Payer: BCBS Trust/PPO |
$235.26
|
| Rate for Payer: BCN Commercial |
$222.74
|
| Rate for Payer: BCN Commercial |
$222.74
|
| Rate for Payer: BCN Commercial |
$182.47
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$229.83
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Cash Price |
$229.84
|
| Rate for Payer: Cofinity Commercial |
$270.06
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$270.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.83
|
| Rate for Payer: Healthscope Commercial |
$287.30
|
| Rate for Payer: Healthscope Commercial |
$287.29
|
| Rate for Payer: Healthscope Commercial |
$235.36
|
| Rate for Payer: Healthscope Whirlpool |
$278.68
|
| Rate for Payer: Healthscope Whirlpool |
$278.67
|
| Rate for Payer: Healthscope Whirlpool |
$228.30
|
| Rate for Payer: Mclaren Commercial |
$258.56
|
| Rate for Payer: Mclaren Commercial |
$258.57
|
| Rate for Payer: Mclaren Commercial |
$211.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.06
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: Nomi Health Commercial |
$235.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.07
|
| Rate for Payer: Priority Health Narrow Network |
$64.06
|
| Rate for Payer: Priority Health Narrow Network |
$64.06
|
| Rate for Payer: Priority Health Narrow Network |
$64.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.82
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: ASR ASR |
$328.25
|
| Rate for Payer: ASR Commercial |
$328.25
|
| Rate for Payer: BCBS Trust/PPO |
$275.76
|
| Rate for Payer: BCN Commercial |
$262.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$318.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Healthscope Whirlpool |
$328.25
|
| Rate for Payer: Mclaren Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.79
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$264.10
|
|
|
Service Code
|
NDC 00904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.64 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$237.69
|
| Rate for Payer: Aetna Medicare |
$132.05
|
| Rate for Payer: ASR ASR |
$256.18
|
| Rate for Payer: ASR Commercial |
$256.18
|
| Rate for Payer: BCBS Complete |
$105.64
|
| Rate for Payer: BCBS Trust/PPO |
$216.27
|
| Rate for Payer: BCN Commercial |
$204.76
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$248.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Healthscope Whirlpool |
$256.18
|
| Rate for Payer: Mclaren Commercial |
$237.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.48
|
| Rate for Payer: Nomi Health Commercial |
$216.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.40
|
| Rate for Payer: Priority Health Narrow Network |
$185.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.41
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$39.48
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: Aetna Medicare |
$19.74
|
| Rate for Payer: ASR ASR |
$38.30
|
| Rate for Payer: ASR Commercial |
$38.30
|
| Rate for Payer: BCBS Complete |
$15.79
|
| Rate for Payer: BCBS Trust/PPO |
$32.33
|
| Rate for Payer: BCN Commercial |
$30.61
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$37.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$39.48
|
| Rate for Payer: Healthscope Whirlpool |
$38.30
|
| Rate for Payer: Mclaren Commercial |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Nomi Health Commercial |
$32.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.59
|
| Rate for Payer: Priority Health Narrow Network |
$27.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.74
|
|
