|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$140.59
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.24 |
| Max. Negotiated Rate |
$126.53 |
| Rate for Payer: Aetna Commercial |
$119.50
|
| Rate for Payer: Aetna Medicare |
$70.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.38
|
| Rate for Payer: BCBS Complete |
$56.24
|
| Rate for Payer: Cash Price |
$112.47
|
| Rate for Payer: Cofinity Commercial |
$120.91
|
| Rate for Payer: Cofinity Commercial |
$98.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.47
|
| Rate for Payer: Healthscope Commercial |
$126.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.50
|
| Rate for Payer: PHP Commercial |
$119.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.38
|
| Rate for Payer: Priority Health SBD |
$88.57
|
|
|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$140.59
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$126.53 |
| Rate for Payer: Aetna Commercial |
$119.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.38
|
| Rate for Payer: Cash Price |
$112.47
|
| Rate for Payer: Cofinity Commercial |
$120.91
|
| Rate for Payer: Cofinity Commercial |
$98.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.47
|
| Rate for Payer: Healthscope Commercial |
$126.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.50
|
| Rate for Payer: PHP Commercial |
$119.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.38
|
| Rate for Payer: Priority Health SBD |
$88.57
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 00904636161
|
| Hospital Charge Code |
18312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$361.66 |
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna Medicare |
$200.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health SBD |
$253.17
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 00904636161
|
| Hospital Charge Code |
18312
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.17 |
| Max. Negotiated Rate |
$361.66 |
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health SBD |
$253.17
|
|
|
RISPERIDONE 4 MG TABLET
|
Facility
|
IP
|
$197.60
|
|
|
Service Code
|
NDC 00904636261
|
| Hospital Charge Code |
18310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.49 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.44
|
| Rate for Payer: Priority Health SBD |
$124.49
|
|
|
RISPERIDONE 4 MG TABLET
|
Facility
|
OP
|
$197.60
|
|
|
Service Code
|
NDC 00904636261
|
| Hospital Charge Code |
18310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.04 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: BCBS Complete |
$79.04
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.44
|
| Rate for Payer: Priority Health SBD |
$124.49
|
|
|
RISPERIDONE 4 MG TABLET
|
Facility
|
IP
|
$3.70
|
|
|
Service Code
|
NDC 68084027711
|
| Hospital Charge Code |
18310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.33
|
|
|
RISPERIDONE 4 MG TABLET
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 68084027711
|
| Hospital Charge Code |
18310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.33
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
OP
|
$927.74
|
|
|
Service Code
|
NDC 00074333330
|
| Hospital Charge Code |
100995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$371.10 |
| Max. Negotiated Rate |
$834.97 |
| Rate for Payer: Aetna Commercial |
$788.58
|
| Rate for Payer: Aetna Medicare |
$463.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.03
|
| Rate for Payer: BCBS Complete |
$371.10
|
| Rate for Payer: Cash Price |
$742.19
|
| Rate for Payer: Cofinity Commercial |
$649.42
|
| Rate for Payer: Cofinity Commercial |
$797.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.19
|
| Rate for Payer: Healthscope Commercial |
$834.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.58
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.03
|
| Rate for Payer: Priority Health SBD |
$584.48
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
IP
|
$927.74
|
|
|
Service Code
|
NDC 00074333330
|
| Hospital Charge Code |
100995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$584.48 |
| Max. Negotiated Rate |
$834.97 |
| Rate for Payer: Aetna Commercial |
$788.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.03
|
| Rate for Payer: Cash Price |
$742.19
|
| Rate for Payer: Cofinity Commercial |
$649.42
|
| Rate for Payer: Cofinity Commercial |
$797.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$649.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.19
|
| Rate for Payer: Healthscope Commercial |
$834.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.58
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.03
|
| Rate for Payer: Priority Health SBD |
$584.48
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$4,218.45
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.13 |
| Max. Negotiated Rate |
$3,796.60 |
| Rate for Payer: Aetna Commercial |
$3,585.68
|
| Rate for Payer: Aetna Commercial |
$17,928.40
|
| Rate for Payer: Aetna Medicare |
$79.80
|
| Rate for Payer: Aetna Medicare |
$79.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,741.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,709.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.91
|
| Rate for Payer: BCBS Complete |
$43.18
|
| Rate for Payer: BCBS Complete |
$43.18
|
| Rate for Payer: BCBS MAPPO |
$76.73
|
| Rate for Payer: BCBS MAPPO |
$76.73
|
| Rate for Payer: BCBS Trust/PPO |
$218.39
|
| Rate for Payer: BCBS Trust/PPO |
$218.39
|
| Rate for Payer: BCN Commercial |
$218.39
|
| Rate for Payer: BCN Commercial |
$218.39
|
| Rate for Payer: BCN Medicare Advantage |
$76.73
|
| Rate for Payer: BCN Medicare Advantage |
$76.73
|
| Rate for Payer: Cash Price |
$16,873.78
|
| Rate for Payer: Cash Price |
$16,873.78
|
| Rate for Payer: Cash Price |
$3,374.76
|
| Rate for Payer: Cash Price |
$3,374.76
|
| Rate for Payer: Cofinity Commercial |
$2,952.92
|
| Rate for Payer: Cofinity Commercial |
$14,764.56
|
| Rate for Payer: Cofinity Commercial |
$3,627.87
|
| Rate for Payer: Cofinity Commercial |
$18,139.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,764.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,952.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,374.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,873.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.73
|
| Rate for Payer: Healthscope Commercial |
$3,796.60
|
| Rate for Payer: Healthscope Commercial |
$18,983.01
|
| Rate for Payer: Mclaren Medicaid |
$41.13
|
| Rate for Payer: Mclaren Medicaid |
$41.13
|
| Rate for Payer: Mclaren Medicare |
$76.73
|
| Rate for Payer: Mclaren Medicare |
$76.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.57
|
| Rate for Payer: Meridian Medicaid |
$43.18
|
| Rate for Payer: Meridian Medicaid |
$43.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,928.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.68
|
| Rate for Payer: Nomi Health Commercial |
$230.19
|
| Rate for Payer: Nomi Health Commercial |
$230.19
|
| Rate for Payer: PACE Medicare |
$72.89
|
| Rate for Payer: PACE Medicare |
$72.89
|
| Rate for Payer: PACE SWMI |
$76.73
|
| Rate for Payer: PACE SWMI |
$76.73
|
| Rate for Payer: PHP Commercial |
$3,585.68
|
| Rate for Payer: PHP Commercial |
$17,928.40
|
| Rate for Payer: PHP Medicare Advantage |
$76.73
|
| Rate for Payer: PHP Medicare Advantage |
$76.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,709.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,741.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.52
|
| Rate for Payer: Priority Health Medicare |
$76.73
|
| Rate for Payer: Priority Health Medicare |
$76.73
|
| Rate for Payer: Priority Health Narrow Network |
$178.02
|
| Rate for Payer: Priority Health Narrow Network |
$178.02
|
| Rate for Payer: Priority Health SBD |
$2,657.62
|
| Rate for Payer: Priority Health SBD |
$13,288.10
|
| Rate for Payer: Railroad Medicare Medicare |
$76.73
|
| Rate for Payer: Railroad Medicare Medicare |
$76.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.73
|
| Rate for Payer: UHC Medicare Advantage |
$76.73
|
| Rate for Payer: UHC Medicare Advantage |
$76.73
|
| Rate for Payer: UHCCP Medicaid |
$43.20
|
| Rate for Payer: UHCCP Medicaid |
$43.20
|
| Rate for Payer: VA VA |
$76.73
|
| Rate for Payer: VA VA |
$76.73
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$21,092.23
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,288.10 |
| Max. Negotiated Rate |
$18,983.01 |
| Rate for Payer: Aetna Commercial |
$17,928.40
|
| Rate for Payer: Aetna Commercial |
$3,585.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,709.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,741.99
|
| Rate for Payer: Cash Price |
$16,873.78
|
| Rate for Payer: Cash Price |
$3,374.76
|
| Rate for Payer: Cofinity Commercial |
$14,764.56
|
| Rate for Payer: Cofinity Commercial |
$2,952.92
|
| Rate for Payer: Cofinity Commercial |
$3,627.87
|
| Rate for Payer: Cofinity Commercial |
$18,139.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,952.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,764.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,873.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,374.76
|
| Rate for Payer: Healthscope Commercial |
$18,983.01
|
| Rate for Payer: Healthscope Commercial |
$3,796.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,928.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.68
|
| Rate for Payer: PHP Commercial |
$17,928.40
|
| Rate for Payer: PHP Commercial |
$3,585.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,741.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,709.95
|
| Rate for Payer: Priority Health SBD |
$2,657.62
|
| Rate for Payer: Priority Health SBD |
$13,288.10
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
IP
|
$17,099.12
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,772.45 |
| Max. Negotiated Rate |
$15,389.21 |
| Rate for Payer: Aetna Commercial |
$14,534.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,114.43
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cofinity Commercial |
$11,969.38
|
| Rate for Payer: Cofinity Commercial |
$14,705.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,969.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,679.30
|
| Rate for Payer: Healthscope Commercial |
$15,389.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,534.25
|
| Rate for Payer: PHP Commercial |
$14,534.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,114.43
|
| Rate for Payer: Priority Health SBD |
$10,772.45
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
OP
|
$17,099.12
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$15,389.21 |
| Rate for Payer: Aetna Commercial |
$14,534.25
|
| Rate for Payer: Aetna Medicare |
$38.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,114.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.72
|
| Rate for Payer: BCBS Complete |
$20.59
|
| Rate for Payer: BCBS MAPPO |
$36.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.33
|
| Rate for Payer: BCN Commercial |
$104.33
|
| Rate for Payer: BCN Medicare Advantage |
$36.58
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cofinity Commercial |
$14,705.24
|
| Rate for Payer: Cofinity Commercial |
$11,969.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,969.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,679.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.58
|
| Rate for Payer: Healthscope Commercial |
$15,389.21
|
| Rate for Payer: Mclaren Medicaid |
$19.61
|
| Rate for Payer: Mclaren Medicare |
$36.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.41
|
| Rate for Payer: Meridian Medicaid |
$20.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,534.25
|
| Rate for Payer: Nomi Health Commercial |
$109.74
|
| Rate for Payer: PACE Medicare |
$34.75
|
| Rate for Payer: PACE SWMI |
$36.58
|
| Rate for Payer: PHP Commercial |
$14,534.25
|
| Rate for Payer: PHP Medicare Advantage |
$36.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,114.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.32
|
| Rate for Payer: Priority Health Medicare |
$36.58
|
| Rate for Payer: Priority Health Narrow Network |
$85.06
|
| Rate for Payer: Priority Health SBD |
$10,772.45
|
| Rate for Payer: Railroad Medicare Medicare |
$36.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.58
|
| Rate for Payer: UHC Medicare Advantage |
$36.58
|
| Rate for Payer: UHCCP Medicaid |
$20.59
|
| Rate for Payer: VA VA |
$36.58
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$13,325.88
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$11,993.29 |
| Rate for Payer: Aetna Commercial |
$11,327.00
|
| Rate for Payer: Aetna Commercial |
$2,265.40
|
| Rate for Payer: Aetna Medicare |
$33.10
|
| Rate for Payer: Aetna Medicare |
$33.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,661.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.79
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS MAPPO |
$31.83
|
| Rate for Payer: BCBS MAPPO |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$122.35
|
| Rate for Payer: BCBS Trust/PPO |
$122.35
|
| Rate for Payer: BCN Commercial |
$122.35
|
| Rate for Payer: BCN Commercial |
$122.35
|
| Rate for Payer: BCN Medicare Advantage |
$31.83
|
| Rate for Payer: BCN Medicare Advantage |
$31.83
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$10,660.70
|
| Rate for Payer: Cash Price |
$10,660.70
|
| Rate for Payer: Cofinity Commercial |
$11,460.26
|
| Rate for Payer: Cofinity Commercial |
$2,292.05
|
| Rate for Payer: Cofinity Commercial |
$1,865.63
|
| Rate for Payer: Cofinity Commercial |
$9,328.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,328.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,865.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,660.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.83
|
| Rate for Payer: Healthscope Commercial |
$2,398.66
|
| Rate for Payer: Healthscope Commercial |
$11,993.29
|
| Rate for Payer: Mclaren Medicaid |
$17.06
|
| Rate for Payer: Mclaren Medicaid |
$17.06
|
| Rate for Payer: Mclaren Medicare |
$31.83
|
| Rate for Payer: Mclaren Medicare |
$31.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.42
|
| Rate for Payer: Meridian Medicaid |
$17.91
|
| Rate for Payer: Meridian Medicaid |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,327.00
|
| Rate for Payer: Nomi Health Commercial |
$95.49
|
| Rate for Payer: Nomi Health Commercial |
$95.49
|
| Rate for Payer: PACE Medicare |
$30.24
|
| Rate for Payer: PACE Medicare |
$30.24
|
| Rate for Payer: PACE SWMI |
$31.83
|
| Rate for Payer: PACE SWMI |
$31.83
|
| Rate for Payer: PHP Commercial |
$11,327.00
|
| Rate for Payer: PHP Commercial |
$2,265.40
|
| Rate for Payer: PHP Medicare Advantage |
$31.83
|
| Rate for Payer: PHP Medicare Advantage |
$31.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,661.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.67
|
| Rate for Payer: Priority Health Medicare |
$31.83
|
| Rate for Payer: Priority Health Medicare |
$31.83
|
| Rate for Payer: Priority Health Narrow Network |
$77.34
|
| Rate for Payer: Priority Health Narrow Network |
$77.34
|
| Rate for Payer: Priority Health SBD |
$1,679.06
|
| Rate for Payer: Priority Health SBD |
$8,395.30
|
| Rate for Payer: Railroad Medicare Medicare |
$31.83
|
| Rate for Payer: Railroad Medicare Medicare |
$31.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.83
|
| Rate for Payer: UHC Medicare Advantage |
$31.83
|
| Rate for Payer: UHC Medicare Advantage |
$31.83
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: UHCCP Medicaid |
$17.92
|
| Rate for Payer: VA VA |
$31.83
|
| Rate for Payer: VA VA |
$31.83
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13,325.88
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,395.30 |
| Max. Negotiated Rate |
$11,993.29 |
| Rate for Payer: Aetna Commercial |
$11,327.00
|
| Rate for Payer: Aetna Commercial |
$2,265.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,661.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.37
|
| Rate for Payer: Cash Price |
$10,660.70
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$11,460.26
|
| Rate for Payer: Cofinity Commercial |
$1,865.63
|
| Rate for Payer: Cofinity Commercial |
$2,292.05
|
| Rate for Payer: Cofinity Commercial |
$9,328.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,865.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,328.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,660.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Healthscope Commercial |
$11,993.29
|
| Rate for Payer: Healthscope Commercial |
$2,398.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,327.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: PHP Commercial |
$11,327.00
|
| Rate for Payer: PHP Commercial |
$2,265.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,661.82
|
| Rate for Payer: Priority Health SBD |
$1,679.06
|
| Rate for Payer: Priority Health SBD |
$8,395.30
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,689.86
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.71 |
| Max. Negotiated Rate |
$14,120.87 |
| Rate for Payer: Aetna Commercial |
$13,336.38
|
| Rate for Payer: Aetna Commercial |
$2,667.28
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,039.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,198.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.98
|
| Rate for Payer: BCBS Complete |
$20.70
|
| Rate for Payer: BCBS Complete |
$20.70
|
| Rate for Payer: BCBS MAPPO |
$36.78
|
| Rate for Payer: BCBS MAPPO |
$36.78
|
| Rate for Payer: BCBS Trust/PPO |
$119.25
|
| Rate for Payer: BCBS Trust/PPO |
$119.25
|
| Rate for Payer: BCN Commercial |
$119.25
|
| Rate for Payer: BCN Commercial |
$119.25
|
| Rate for Payer: BCN Medicare Advantage |
$36.78
|
| Rate for Payer: BCN Medicare Advantage |
$36.78
|
| Rate for Payer: Cash Price |
$2,510.38
|
| Rate for Payer: Cash Price |
$2,510.38
|
| Rate for Payer: Cash Price |
$12,551.89
|
| Rate for Payer: Cash Price |
$12,551.89
|
| Rate for Payer: Cofinity Commercial |
$10,982.90
|
| Rate for Payer: Cofinity Commercial |
$2,698.66
|
| Rate for Payer: Cofinity Commercial |
$2,196.59
|
| Rate for Payer: Cofinity Commercial |
$13,493.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,982.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,196.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,551.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,510.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.78
|
| Rate for Payer: Healthscope Commercial |
$2,824.18
|
| Rate for Payer: Healthscope Commercial |
$14,120.87
|
| Rate for Payer: Mclaren Medicaid |
$19.71
|
| Rate for Payer: Mclaren Medicaid |
$19.71
|
| Rate for Payer: Mclaren Medicare |
$36.78
|
| Rate for Payer: Mclaren Medicare |
$36.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.62
|
| Rate for Payer: Meridian Medicaid |
$20.70
|
| Rate for Payer: Meridian Medicaid |
$20.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,667.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,336.38
|
| Rate for Payer: Nomi Health Commercial |
$110.34
|
| Rate for Payer: Nomi Health Commercial |
$110.34
|
| Rate for Payer: PACE Medicare |
$34.94
|
| Rate for Payer: PACE Medicare |
$34.94
|
| Rate for Payer: PACE SWMI |
$36.78
|
| Rate for Payer: PACE SWMI |
$36.78
|
| Rate for Payer: PHP Commercial |
$13,336.38
|
| Rate for Payer: PHP Commercial |
$2,667.28
|
| Rate for Payer: PHP Medicare Advantage |
$36.78
|
| Rate for Payer: PHP Medicare Advantage |
$36.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,198.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,039.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.22
|
| Rate for Payer: Priority Health Medicare |
$36.78
|
| Rate for Payer: Priority Health Medicare |
$36.78
|
| Rate for Payer: Priority Health Narrow Network |
$88.98
|
| Rate for Payer: Priority Health Narrow Network |
$88.98
|
| Rate for Payer: Priority Health SBD |
$1,976.93
|
| Rate for Payer: Priority Health SBD |
$9,884.61
|
| Rate for Payer: Railroad Medicare Medicare |
$36.78
|
| Rate for Payer: Railroad Medicare Medicare |
$36.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.78
|
| Rate for Payer: UHC Medicare Advantage |
$36.78
|
| Rate for Payer: UHCCP Medicaid |
$20.71
|
| Rate for Payer: UHCCP Medicaid |
$20.71
|
| Rate for Payer: VA VA |
$36.78
|
| Rate for Payer: VA VA |
$36.78
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,689.86
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,884.61 |
| Max. Negotiated Rate |
$14,120.87 |
| Rate for Payer: Aetna Commercial |
$13,336.38
|
| Rate for Payer: Aetna Commercial |
$2,667.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,198.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,039.69
|
| Rate for Payer: Cash Price |
$12,551.89
|
| Rate for Payer: Cash Price |
$2,510.38
|
| Rate for Payer: Cofinity Commercial |
$10,982.90
|
| Rate for Payer: Cofinity Commercial |
$2,196.59
|
| Rate for Payer: Cofinity Commercial |
$2,698.66
|
| Rate for Payer: Cofinity Commercial |
$13,493.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,196.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,982.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,551.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,510.38
|
| Rate for Payer: Healthscope Commercial |
$14,120.87
|
| Rate for Payer: Healthscope Commercial |
$2,824.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,336.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,667.28
|
| Rate for Payer: PHP Commercial |
$13,336.38
|
| Rate for Payer: PHP Commercial |
$2,667.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,039.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,198.41
|
| Rate for Payer: Priority Health SBD |
$1,976.93
|
| Rate for Payer: Priority Health SBD |
$9,884.61
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$11,924.32
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$10,731.89 |
| Rate for Payer: Aetna Commercial |
$10,135.67
|
| Rate for Payer: Aetna Commercial |
$2,027.14
|
| Rate for Payer: Aetna Medicare |
$24.53
|
| Rate for Payer: Aetna Medicare |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,550.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,750.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.49
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS MAPPO |
$23.59
|
| Rate for Payer: BCBS MAPPO |
$23.59
|
| Rate for Payer: BCBS Trust/PPO |
$57.22
|
| Rate for Payer: BCBS Trust/PPO |
$57.22
|
| Rate for Payer: BCN Commercial |
$57.22
|
| Rate for Payer: BCN Commercial |
$57.22
|
| Rate for Payer: BCN Medicare Advantage |
$23.59
|
| Rate for Payer: BCN Medicare Advantage |
$23.59
|
| Rate for Payer: Cash Price |
$1,907.90
|
| Rate for Payer: Cash Price |
$1,907.90
|
| Rate for Payer: Cash Price |
$9,539.46
|
| Rate for Payer: Cash Price |
$9,539.46
|
| Rate for Payer: Cofinity Commercial |
$10,254.92
|
| Rate for Payer: Cofinity Commercial |
$2,050.99
|
| Rate for Payer: Cofinity Commercial |
$1,669.41
|
| Rate for Payer: Cofinity Commercial |
$8,347.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,347.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,669.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,539.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,907.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.59
|
| Rate for Payer: Healthscope Commercial |
$2,146.38
|
| Rate for Payer: Healthscope Commercial |
$10,731.89
|
| Rate for Payer: Mclaren Medicaid |
$12.64
|
| Rate for Payer: Mclaren Medicaid |
$12.64
|
| Rate for Payer: Mclaren Medicare |
$23.59
|
| Rate for Payer: Mclaren Medicare |
$23.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.77
|
| Rate for Payer: Meridian Medicaid |
$13.28
|
| Rate for Payer: Meridian Medicaid |
$13.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,027.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,135.67
|
| Rate for Payer: Nomi Health Commercial |
$70.77
|
| Rate for Payer: Nomi Health Commercial |
$70.77
|
| Rate for Payer: PACE Medicare |
$22.41
|
| Rate for Payer: PACE Medicare |
$22.41
|
| Rate for Payer: PACE SWMI |
$23.59
|
| Rate for Payer: PACE SWMI |
$23.59
|
| Rate for Payer: PHP Commercial |
$10,135.67
|
| Rate for Payer: PHP Commercial |
$2,027.14
|
| Rate for Payer: PHP Medicare Advantage |
$23.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,750.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.57
|
| Rate for Payer: Priority Health Medicare |
$23.59
|
| Rate for Payer: Priority Health Medicare |
$23.59
|
| Rate for Payer: Priority Health Narrow Network |
$51.66
|
| Rate for Payer: Priority Health Narrow Network |
$51.66
|
| Rate for Payer: Priority Health SBD |
$1,502.47
|
| Rate for Payer: Priority Health SBD |
$7,512.32
|
| Rate for Payer: Railroad Medicare Medicare |
$23.59
|
| Rate for Payer: Railroad Medicare Medicare |
$23.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.59
|
| Rate for Payer: UHC Medicare Advantage |
$23.59
|
| Rate for Payer: UHC Medicare Advantage |
$23.59
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: UHCCP Medicaid |
$13.28
|
| Rate for Payer: VA VA |
$23.59
|
| Rate for Payer: VA VA |
$23.59
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$11,924.32
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,512.32 |
| Max. Negotiated Rate |
$10,731.89 |
| Rate for Payer: Aetna Commercial |
$10,135.67
|
| Rate for Payer: Aetna Commercial |
$2,027.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,750.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,550.17
|
| Rate for Payer: Cash Price |
$9,539.46
|
| Rate for Payer: Cash Price |
$1,907.90
|
| Rate for Payer: Cofinity Commercial |
$10,254.92
|
| Rate for Payer: Cofinity Commercial |
$1,669.41
|
| Rate for Payer: Cofinity Commercial |
$2,050.99
|
| Rate for Payer: Cofinity Commercial |
$8,347.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,669.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$8,347.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,539.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,907.90
|
| Rate for Payer: Healthscope Commercial |
$10,731.89
|
| Rate for Payer: Healthscope Commercial |
$2,146.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,135.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,027.14
|
| Rate for Payer: PHP Commercial |
$10,135.67
|
| Rate for Payer: PHP Commercial |
$2,027.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,750.81
|
| Rate for Payer: Priority Health SBD |
$1,502.47
|
| Rate for Payer: Priority Health SBD |
$7,512.32
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 50458058001
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.10 |
| 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 Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| 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: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| 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 |
$9.40 |
| 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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| 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 Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| 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: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
|
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 Commercial |
$20.21
|
| Rate for Payer: Cofinity Commercial |
$16.45
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
|
