|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$12,551.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$11,296.62 |
| Rate for Payer: Aetna Commercial |
$10,669.03
|
| Rate for Payer: Aetna Commercial |
$2,133.81
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,158.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$105.37
|
| Rate for Payer: BCBS Trust/PPO |
$105.37
|
| Rate for Payer: BCN Commercial |
$105.37
|
| Rate for Payer: BCN Commercial |
$105.37
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cofinity Advantage |
$1,757.25
|
| Rate for Payer: Cofinity Advantage |
$8,786.26
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Cofinity Commercial |
$10,794.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,041.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| Rate for Payer: Mclaren Medicaid |
$10.60
|
| Rate for Payer: Mclaren Medicaid |
$10.60
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.81
|
| Rate for Payer: Nomi Health Commercial |
$60.78
|
| Rate for Payer: Nomi Health Commercial |
$60.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,413.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,882.77
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$2,133.81
|
| Rate for Payer: PHP Commercial |
$10,669.03
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$83.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$83.61
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$1,581.53
|
| Rate for Payer: Priority Health SBD |
$7,907.63
|
| Rate for Payer: Priority Health Tiered Network |
$66.89
|
| Rate for Payer: Priority Health Tiered Network |
$66.89
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC Core |
$34.49
|
| Rate for Payer: UHC Core |
$34.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Exchange |
$34.49
|
| Rate for Payer: UHC Exchange |
$34.49
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: VA VA |
$20.26
|
| Rate for Payer: VA VA |
$20.26
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,551.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,907.63 |
| Max. Negotiated Rate |
$11,296.62 |
| Rate for Payer: Aetna Commercial |
$10,669.03
|
| Rate for Payer: Aetna Commercial |
$2,133.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,158.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.73
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cofinity Advantage |
$8,786.26
|
| Rate for Payer: Cofinity Advantage |
$1,757.25
|
| Rate for Payer: Cofinity Commercial |
$10,794.55
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,041.44
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,413.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,882.77
|
| Rate for Payer: PHP Commercial |
$10,669.03
|
| Rate for Payer: PHP Commercial |
$2,133.81
|
| Rate for Payer: Priority Health SBD |
$7,907.63
|
| Rate for Payer: Priority Health SBD |
$1,581.53
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,037.61
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,283.69 |
| Max. Negotiated Rate |
$1,833.85 |
| Rate for Payer: Aetna Commercial |
$1,731.97
|
| Rate for Payer: Aetna Commercial |
$8,185.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,324.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,259.75
|
| Rate for Payer: Cash Price |
$1,630.09
|
| Rate for Payer: Cash Price |
$7,704.30
|
| Rate for Payer: Cofinity Advantage |
$1,426.33
|
| Rate for Payer: Cofinity Advantage |
$6,741.27
|
| Rate for Payer: Cofinity Commercial |
$1,752.34
|
| Rate for Payer: Cofinity Commercial |
$8,282.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,704.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.09
|
| Rate for Payer: Healthscope Commercial |
$8,667.34
|
| Rate for Payer: Healthscope Commercial |
$1,833.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,731.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,185.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,528.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,222.78
|
| Rate for Payer: PHP Commercial |
$1,731.97
|
| Rate for Payer: PHP Commercial |
$8,185.82
|
| Rate for Payer: Priority Health SBD |
$1,283.69
|
| Rate for Payer: Priority Health SBD |
$6,067.14
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,037.61
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$1,833.85 |
| Rate for Payer: Aetna Commercial |
$1,731.97
|
| Rate for Payer: Aetna Commercial |
$8,185.82
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,259.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,324.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.11
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$13.69
|
| Rate for Payer: BCBS MAPPO |
$13.69
|
| Rate for Payer: BCBS Trust/PPO |
$42.35
|
| Rate for Payer: BCBS Trust/PPO |
$42.35
|
| Rate for Payer: BCN Commercial |
$42.35
|
| Rate for Payer: BCN Commercial |
$42.35
|
| Rate for Payer: BCN Medicare Advantage |
$13.69
|
| Rate for Payer: BCN Medicare Advantage |
$13.69
|
| Rate for Payer: Cash Price |
$1,630.09
|
| Rate for Payer: Cash Price |
$7,704.30
|
| Rate for Payer: Cash Price |
$7,704.30
|
| Rate for Payer: Cash Price |
$1,630.09
|
| Rate for Payer: Cofinity Advantage |
$6,741.27
|
| Rate for Payer: Cofinity Advantage |
$1,426.33
|
| Rate for Payer: Cofinity Commercial |
$8,282.13
|
| Rate for Payer: Cofinity Commercial |
$1,752.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,704.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.69
|
| Rate for Payer: Healthscope Commercial |
$1,833.85
|
| Rate for Payer: Healthscope Commercial |
$8,667.34
|
| Rate for Payer: Mclaren Medicaid |
$7.16
|
| Rate for Payer: Mclaren Medicaid |
$7.16
|
| Rate for Payer: Mclaren Medicare |
$13.69
|
| Rate for Payer: Mclaren Medicare |
$13.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.37
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,731.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,185.82
|
| Rate for Payer: Nomi Health Commercial |
$41.07
|
| Rate for Payer: Nomi Health Commercial |
$41.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,528.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,222.78
|
| Rate for Payer: PACE Medicare |
$13.01
|
| Rate for Payer: PACE Medicare |
$13.01
|
| Rate for Payer: PACE SWMI |
$13.69
|
| Rate for Payer: PACE SWMI |
$13.69
|
| Rate for Payer: PHP Commercial |
$8,185.82
|
| Rate for Payer: PHP Commercial |
$1,731.97
|
| Rate for Payer: PHP Medicare Advantage |
$13.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.82
|
| Rate for Payer: Priority Health Medicare |
$13.69
|
| Rate for Payer: Priority Health Medicare |
$13.69
|
| Rate for Payer: Priority Health SBD |
$6,067.14
|
| Rate for Payer: Priority Health SBD |
$1,283.69
|
| Rate for Payer: Priority Health Tiered Network |
$70.26
|
| Rate for Payer: Priority Health Tiered Network |
$70.26
|
| Rate for Payer: Railroad Medicare Medicare |
$13.69
|
| Rate for Payer: Railroad Medicare Medicare |
$13.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.69
|
| Rate for Payer: UHC Exchange |
$21.90
|
| Rate for Payer: UHC Exchange |
$21.90
|
| Rate for Payer: UHC Medicaid |
$7.16
|
| Rate for Payer: UHC Medicaid |
$7.16
|
| Rate for Payer: UHCCP Medicaid |
$7.16
|
| Rate for Payer: UHCCP Medicaid |
$7.16
|
| Rate for Payer: VA VA |
$13.69
|
| Rate for Payer: VA VA |
$13.69
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 50458058001
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Advantage |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.16
|
| Rate for Payer: UHC Core |
$0.13
|
| Rate for Payer: UHC Exchange |
$0.09
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 50458058001
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Advantage |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health SBD |
$0.15
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.28
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Exchange |
$9.24
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.28
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Exchange |
$9.24
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.58
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: UHC Exchange |
$2.77
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057910
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458057930
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057910
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.28
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Exchange |
$9.24
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458057930
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.58
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: UHC Exchange |
$2.77
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 50458057718
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.50
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Advantage |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.73
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health SBD |
$26.65
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057710
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 50458057701
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Advantage |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health SBD |
$0.15
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$42.30
|
|
|
Service Code
|
NDC 50458057718
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.95
|
| Rate for Payer: Aetna Medicare |
$21.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.50
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Advantage |
$29.61
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.73
|
| Rate for Payer: PHP Commercial |
$35.95
|
| Rate for Payer: Priority Health SBD |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.50
|
| Rate for Payer: UHC Core |
$22.04
|
| Rate for Payer: UHC Exchange |
$16.62
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 50458057701
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Advantage |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.16
|
| Rate for Payer: UHC Core |
$0.13
|
| Rate for Payer: UHC Exchange |
$0.09
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057710
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.28
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Exchange |
$9.24
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$78.61
|
|
|
Service Code
|
NDC 00078050361
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna Medicare |
$39.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: BCBS Complete |
$31.44
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.10
|
| Rate for Payer: UHC Core |
$40.96
|
| Rate for Payer: UHC Exchange |
$30.89
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,358.20
|
|
|
Service Code
|
NDC 00078050315
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,485.67 |
| Max. Negotiated Rate |
$2,122.38 |
| Rate for Payer: Aetna Commercial |
$2,004.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.83
|
| Rate for Payer: Cash Price |
$1,886.56
|
| Rate for Payer: Cofinity Advantage |
$1,650.74
|
| Rate for Payer: Cofinity Commercial |
$2,028.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,886.56
|
| Rate for Payer: Healthscope Commercial |
$2,122.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,004.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.65
|
| Rate for Payer: PHP Commercial |
$2,004.47
|
| Rate for Payer: Priority Health SBD |
$1,485.67
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$281.52
|
|
|
Service Code
|
NDC 65162074934
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.64 |
| Max. Negotiated Rate |
$253.37 |
| Rate for Payer: Aetna Commercial |
$239.29
|
| Rate for Payer: Aetna Medicare |
$140.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.99
|
| Rate for Payer: BCBS Complete |
$112.61
|
| Rate for Payer: Cash Price |
$225.22
|
| Rate for Payer: Cofinity Advantage |
$197.06
|
| Rate for Payer: Cofinity Commercial |
$242.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.22
|
| Rate for Payer: Healthscope Commercial |
$253.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.14
|
| Rate for Payer: PHP Commercial |
$239.29
|
| Rate for Payer: Priority Health SBD |
$177.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.99
|
| Rate for Payer: UHC Core |
$146.67
|
| Rate for Payer: UHC Exchange |
$110.64
|
|
