|
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 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
|
OP
|
$235.36
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$235.36 |
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Aetna Commercial |
$258.56
|
| Rate for Payer: Aetna Commercial |
$258.57
|
| Rate for Payer: Aetna Medicare |
$143.65
|
| Rate for Payer: Aetna Medicare |
$143.65
|
| Rate for Payer: Aetna Medicare |
$117.68
|
| 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 |
$278.68
|
| Rate for Payer: ASR Commercial |
$278.67
|
| Rate for Payer: ASR Commercial |
$228.30
|
| 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 |
$192.74
|
| Rate for Payer: BCBS Trust/PPO |
$235.26
|
| Rate for Payer: BCBS Trust/PPO |
$235.27
|
| Rate for Payer: BCN Commercial |
$222.74
|
| Rate for Payer: BCN Commercial |
$182.47
|
| 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 |
$211.82
|
| Rate for Payer: Mclaren Commercial |
$258.56
|
| 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 |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.21
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: Nomi Health Commercial |
$235.58
|
| Rate for Payer: Nomi Health Commercial |
$235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.73
|
| Rate for Payer: Priority Health Narrow Network |
$201.40
|
| Rate for Payer: Priority Health Narrow Network |
$164.99
|
| Rate for Payer: Priority Health Narrow Network |
$201.39
|
| 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
|
|
|
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 |
$244.21
|
| 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 |
$186.75
|
| 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
|
|
|
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
|
|
|
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 |
$224.49
|
| 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
|
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
|
IP
|
$264.10
|
|
|
Service Code
|
NDC 00904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.66 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$237.69
|
| Rate for Payer: ASR ASR |
$256.18
|
| Rate for Payer: ASR Commercial |
$256.18
|
| Rate for Payer: BCBS Trust/PPO |
$215.22
|
| 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 |
$224.49
|
| Rate for Payer: Nomi Health Commercial |
$216.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.41
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: ASR ASR |
$328.25
|
| Rate for Payer: ASR Commercial |
$328.25
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS Trust/PPO |
$277.12
|
| 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: Priority Health HMO/PPO/Tiered Network |
$296.51
|
| Rate for Payer: Priority Health Narrow Network |
$237.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.79
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: ASR ASR |
$38.30
|
| Rate for Payer: ASR Commercial |
$38.30
|
| Rate for Payer: BCBS Trust/PPO |
$32.17
|
| 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: UHC All Payor (Choice/PPO) + Core |
$34.74
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$2,665.18 |
| Rate for Payer: Aetna Commercial |
$2,398.66
|
| Rate for Payer: Aetna Medicare |
$29.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36.73
|
| Rate for Payer: ASR ASR |
$2,585.22
|
| Rate for Payer: ASR Commercial |
$2,585.22
|
| Rate for Payer: BCBS Complete |
$16.54
|
| Rate for Payer: BCBS MAPPO |
$29.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.52
|
| Rate for Payer: BCN Commercial |
$2,066.31
|
| Rate for Payer: BCN Medicare Advantage |
$29.38
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$2,505.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$2,665.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,585.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$29.38
|
| Rate for Payer: Mclaren Commercial |
$2,398.66
|
| Rate for Payer: Mclaren Medicaid |
$15.75
|
| Rate for Payer: Mclaren Medicare |
$29.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.85
|
| Rate for Payer: Meridian Medicaid |
$16.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$2,185.45
|
| Rate for Payer: PACE Medicare |
$27.91
|
| Rate for Payer: PACE SWMI |
$29.38
|
| Rate for Payer: PHP Commercial |
$32.32
|
| Rate for Payer: PHP Medicaid |
$15.75
|
| Rate for Payer: PHP Medicare Advantage |
$29.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,335.23
|
| Rate for Payer: Priority Health Medicare |
$29.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,868.29
|
| Rate for Payer: Railroad Medicare Medicare |
$29.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,345.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.38
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.38
|
| Rate for Payer: UHCCP DNSP |
$29.38
|
| Rate for Payer: UHCCP Medicaid |
$15.75
|
| Rate for Payer: VA VA |
$29.38
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,732.37 |
| Max. Negotiated Rate |
$2,665.18 |
| Rate for Payer: Aetna Commercial |
$2,398.66
|
| Rate for Payer: ASR ASR |
$2,585.22
|
| Rate for Payer: ASR Commercial |
$2,585.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.86
|
| Rate for Payer: BCN Commercial |
$2,066.31
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$2,505.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Healthscope Commercial |
$2,665.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,585.22
|
| Rate for Payer: Mclaren Commercial |
$2,398.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$2,185.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,345.36
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,001.73 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.86
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.45 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: Aetna Medicare |
$770.56
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Complete |
$616.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.02
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.45 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: Aetna Medicare |
$770.56
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Complete |
$616.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.02
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,001.73 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.86
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: ASR Commercial |
$23.37
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$23.37
|
| Rate for Payer: Mclaren Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.11
|
| Rate for Payer: Priority Health Narrow Network |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457022899
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: ASR ASR |
$28.10
|
| Rate for Payer: ASR Commercial |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.61
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$28.97
|
| Rate for Payer: Healthscope Whirlpool |
$28.10
|
| Rate for Payer: Mclaren Commercial |
$26.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.62
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.49
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 39822420005
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: ASR ASR |
$22.10
|
| Rate for Payer: ASR Commercial |
$22.10
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$17.66
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Healthscope Whirlpool |
$22.10
|
| Rate for Payer: Mclaren Commercial |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.36
|
| Rate for Payer: Nomi Health Commercial |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.96
|
| Rate for Payer: Priority Health Narrow Network |
$15.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.14
|
|
|
Service Code
|
NDC 00781322092
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna Commercial |
$22.63
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: ASR ASR |
$24.39
|
| Rate for Payer: ASR Commercial |
$24.39
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$20.59
|
| Rate for Payer: BCN Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.11
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Healthscope Whirlpool |
$24.39
|
| Rate for Payer: Mclaren Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.37
|
| Rate for Payer: Nomi Health Commercial |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.03
|
| Rate for Payer: Priority Health Narrow Network |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 39822420006
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: ASR ASR |
$22.10
|
| Rate for Payer: ASR Commercial |
$22.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.56
|
| Rate for Payer: BCN Commercial |
$17.66
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cofinity Commercial |
$21.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Healthscope Whirlpool |
$22.10
|
| Rate for Payer: Mclaren Commercial |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.36
|
| Rate for Payer: Nomi Health Commercial |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.83
|
|
|
Service Code
|
NDC 43066001310
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$23.25
|
| Rate for Payer: ASR ASR |
$25.06
|
| Rate for Payer: ASR Commercial |
$25.06
|
| Rate for Payer: BCBS Trust/PPO |
$21.05
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$25.83
|
| Rate for Payer: Healthscope Whirlpool |
$25.06
|
| Rate for Payer: Mclaren Commercial |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.96
|
| Rate for Payer: Nomi Health Commercial |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.73
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
NDC 72611075701
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$28.84
|
| Rate for Payer: ASR Commercial |
$28.84
|
| Rate for Payer: BCBS Trust/PPO |
$24.23
|
| Rate for Payer: BCN Commercial |
$23.05
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$29.73
|
| Rate for Payer: Healthscope Whirlpool |
$28.84
|
| Rate for Payer: Mclaren Commercial |
$26.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.27
|
| Rate for Payer: Nomi Health Commercial |
$24.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.16
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$17.54 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: ASR ASR |
$17.01
|
| Rate for Payer: ASR Commercial |
$17.01
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCN Commercial |
$13.60
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$17.54
|
| Rate for Payer: Healthscope Whirlpool |
$17.01
|
| Rate for Payer: Mclaren Commercial |
$15.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.44
|
|
