|
RISPERIDONE 1 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$14.06
|
|
|
Service Code
|
NDC 49884-315-52
|
| Hospital Charge Code |
35687
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Aetna Commercial |
$11.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.14
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$12.09
|
| Rate for Payer: Cofinity Commercial |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.95
|
| Rate for Payer: PHP Commercial |
$11.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.84
|
| Rate for Payer: Priority Health SBD |
$8.86
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$92.63
|
|
|
Service Code
|
NDC 65162-673-84
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$83.37 |
| Rate for Payer: Aetna Commercial |
$78.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.21
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cofinity Commercial |
$64.84
|
| Rate for Payer: Cofinity Commercial |
$79.66
|
| Rate for Payer: Healthscope Commercial |
$83.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$78.74
|
| Rate for Payer: PHP Commercial |
$78.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.84
|
| Rate for Payer: Priority Health SBD |
$58.36
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$134.64
|
|
|
Service Code
|
NDC 23155-317-51
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$94.25
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health SBD |
$84.82
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$133.92
|
|
|
Service Code
|
NDC 0054-0063-44
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.37 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.83
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.74
|
| Rate for Payer: Priority Health SBD |
$84.37
|
|
|
RISPERIDONE 1 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
NDC 50458-596-01
|
| Hospital Charge Code |
17377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$377.13 |
| Rate for Payer: Aetna Commercial |
$356.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.37
|
| Rate for Payer: Cash Price |
$335.22
|
| Rate for Payer: Cofinity Commercial |
$293.32
|
| Rate for Payer: Cofinity Commercial |
$360.37
|
| Rate for Payer: Healthscope Commercial |
$377.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.18
|
| Rate for Payer: PHP Commercial |
$356.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.32
|
| Rate for Payer: Priority Health SBD |
$263.99
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 0904-6359-61
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.19 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health SBD |
$213.19
|
|
|
RISPERIDONE 2 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$96.91
|
|
|
Service Code
|
NDC 59746-030-22
|
| Hospital Charge Code |
35688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.22 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.99
|
| Rate for Payer: Cash Price |
$77.53
|
| Rate for Payer: Cofinity Commercial |
$83.34
|
| Rate for Payer: Cofinity Commercial |
$67.84
|
| Rate for Payer: Healthscope Commercial |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.37
|
| Rate for Payer: PHP Commercial |
$82.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.84
|
| Rate for Payer: Priority Health SBD |
$61.05
|
|
|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$137.90
|
|
|
Service Code
|
NDC 59746-040-22
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$124.11 |
| Rate for Payer: Aetna Commercial |
$117.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.64
|
| Rate for Payer: Cash Price |
$110.32
|
| Rate for Payer: Cofinity Commercial |
$96.53
|
| Rate for Payer: Cofinity Commercial |
$118.59
|
| Rate for Payer: Healthscope Commercial |
$124.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.22
|
| Rate for Payer: PHP Commercial |
$117.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.53
|
| Rate for Payer: Priority Health SBD |
$86.88
|
|
|
RISPERIDONE 3 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 0904-6361-61
|
| 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: Healthscope Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$341.57
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.30
|
| Rate for Payer: Priority Health SBD |
$253.17
|
|
|
RISPERIDONE 4 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 0904-6362-61
|
| Hospital Charge Code |
18310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.74 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health SBD |
$285.74
|
|
|
RISPERIDONE 4 MG TABLET
|
Facility
|
IP
|
$367.65
|
|
|
Service Code
|
NDC 68084-277-11
|
| Hospital Charge Code |
18310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.62 |
| Max. Negotiated Rate |
$330.88 |
| Rate for Payer: Aetna Commercial |
$312.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.97
|
| Rate for Payer: Cash Price |
$294.12
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Cofinity Commercial |
$316.18
|
| Rate for Payer: Healthscope Commercial |
$330.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.50
|
| Rate for Payer: PHP Commercial |
$312.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.36
|
| Rate for Payer: Priority Health SBD |
$231.62
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
IP
|
$927.74
|
|
|
Service Code
|
NDC 0074-3333-30
|
| 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: Healthscope Commercial |
$834.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$788.58
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$649.42
|
| Rate for Payer: Priority Health SBD |
$584.48
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
OP
|
$17,928.35
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$16,135.52 |
| Rate for Payer: Aetna Commercial |
$15,239.10
|
| Rate for Payer: Aetna Commercial |
$3,047.82
|
| Rate for Payer: Aetna Medicare |
$82.37
|
| Rate for Payer: Aetna Medicare |
$82.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,330.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,653.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.00
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: BCBS MAPPO |
$79.20
|
| Rate for Payer: BCBS MAPPO |
$79.20
|
| Rate for Payer: BCBS Trust/PPO |
$234.46
|
| Rate for Payer: BCBS Trust/PPO |
$234.46
|
| Rate for Payer: BCN Medicare Advantage |
$79.20
|
| Rate for Payer: BCN Medicare Advantage |
$79.20
|
| Rate for Payer: Cash Price |
$2,868.54
|
| Rate for Payer: Cash Price |
$14,342.68
|
| Rate for Payer: Cash Price |
$2,868.54
|
| Rate for Payer: Cash Price |
$14,342.68
|
| Rate for Payer: Cofinity Commercial |
$3,083.68
|
| Rate for Payer: Cofinity Commercial |
$15,418.38
|
| Rate for Payer: Cofinity Commercial |
$12,549.84
|
| Rate for Payer: Cofinity Commercial |
$2,509.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$16,135.52
|
| Rate for Payer: Healthscope Commercial |
$3,227.10
|
| Rate for Payer: Mclaren Medicaid |
$43.32
|
| Rate for Payer: Mclaren Medicaid |
$43.32
|
| Rate for Payer: Mclaren Medicare |
$79.20
|
| Rate for Payer: Mclaren Medicare |
$79.20
|
| Rate for Payer: Meridian Medicaid |
$45.49
|
| Rate for Payer: Meridian Medicaid |
$45.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,047.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,239.10
|
| Rate for Payer: PACE Medicare |
$75.24
|
| Rate for Payer: PACE Medicare |
$75.24
|
| Rate for Payer: PACE SWMI |
$79.20
|
| Rate for Payer: PACE SWMI |
$79.20
|
| Rate for Payer: PHP Commercial |
$15,239.10
|
| Rate for Payer: PHP Commercial |
$3,047.82
|
| Rate for Payer: PHP Medicare Advantage |
$79.20
|
| Rate for Payer: PHP Medicare Advantage |
$79.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,549.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,509.97
|
| Rate for Payer: Priority Health Medicare |
$79.20
|
| Rate for Payer: Priority Health Medicare |
$79.20
|
| Rate for Payer: Priority Health SBD |
$11,294.86
|
| Rate for Payer: Priority Health SBD |
$2,258.97
|
| Rate for Payer: Railroad Medicare Medicare |
$79.20
|
| Rate for Payer: Railroad Medicare Medicare |
$79.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.20
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
| Rate for Payer: UHC Medicare Advantage |
$81.57
|
| Rate for Payer: VA VA |
$79.20
|
| Rate for Payer: VA VA |
$79.20
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS
|
Facility
|
IP
|
$17,928.35
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,294.86 |
| Max. Negotiated Rate |
$16,135.52 |
| Rate for Payer: Aetna Commercial |
$15,239.10
|
| Rate for Payer: Aetna Commercial |
$3,047.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,330.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,653.43
|
| Rate for Payer: Cash Price |
$14,342.68
|
| Rate for Payer: Cash Price |
$2,868.54
|
| Rate for Payer: Cofinity Commercial |
$15,418.38
|
| Rate for Payer: Cofinity Commercial |
$12,549.84
|
| Rate for Payer: Cofinity Commercial |
$2,509.97
|
| Rate for Payer: Cofinity Commercial |
$3,083.68
|
| Rate for Payer: Healthscope Commercial |
$3,227.10
|
| Rate for Payer: Healthscope Commercial |
$16,135.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,239.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,047.82
|
| Rate for Payer: PHP Commercial |
$3,047.82
|
| Rate for Payer: PHP Commercial |
$15,239.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,549.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,509.97
|
| Rate for Payer: Priority Health SBD |
$11,294.86
|
| Rate for Payer: Priority Health SBD |
$2,258.97
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
OP
|
$14,534.22
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$13,080.80 |
| Rate for Payer: Aetna Commercial |
$12,354.09
|
| Rate for Payer: Aetna Medicare |
$38.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,447.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.76
|
| Rate for Payer: BCBS Complete |
$21.49
|
| Rate for Payer: BCBS MAPPO |
$37.40
|
| Rate for Payer: BCBS Trust/PPO |
$110.74
|
| Rate for Payer: BCN Medicare Advantage |
$37.40
|
| Rate for Payer: Cash Price |
$11,627.38
|
| Rate for Payer: Cash Price |
$11,627.38
|
| Rate for Payer: Cofinity Commercial |
$12,499.43
|
| Rate for Payer: Cofinity Commercial |
$10,173.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.40
|
| Rate for Payer: Healthscope Commercial |
$13,080.80
|
| Rate for Payer: Mclaren Medicaid |
$20.46
|
| Rate for Payer: Mclaren Medicare |
$37.40
|
| Rate for Payer: Meridian Medicaid |
$21.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,354.09
|
| Rate for Payer: PACE Medicare |
$35.53
|
| Rate for Payer: PACE SWMI |
$37.40
|
| Rate for Payer: PHP Commercial |
$12,354.09
|
| Rate for Payer: PHP Medicare Advantage |
$37.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,173.95
|
| Rate for Payer: Priority Health Medicare |
$37.40
|
| Rate for Payer: Priority Health SBD |
$9,156.56
|
| Rate for Payer: Railroad Medicare Medicare |
$37.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.40
|
| Rate for Payer: UHC Medicare Advantage |
$38.53
|
| Rate for Payer: VA VA |
$37.40
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
IP
|
$14,534.22
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,156.56 |
| Max. Negotiated Rate |
$13,080.80 |
| Rate for Payer: Aetna Commercial |
$12,354.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,447.24
|
| Rate for Payer: Cash Price |
$11,627.38
|
| Rate for Payer: Cofinity Commercial |
$10,173.95
|
| Rate for Payer: Cofinity Commercial |
$12,499.43
|
| Rate for Payer: Healthscope Commercial |
$13,080.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12,354.09
|
| Rate for Payer: PHP Commercial |
$12,354.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,173.95
|
| Rate for Payer: Priority Health SBD |
$9,156.56
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,492.98
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,870.58 |
| Max. Negotiated Rate |
$11,243.68 |
| Rate for Payer: Aetna Commercial |
$10,619.03
|
| Rate for Payer: Aetna Commercial |
$2,123.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,120.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.09
|
| Rate for Payer: Cash Price |
$1,998.88
|
| Rate for Payer: Cash Price |
$9,994.38
|
| Rate for Payer: Cofinity Commercial |
$2,148.80
|
| Rate for Payer: Cofinity Commercial |
$8,745.09
|
| Rate for Payer: Cofinity Commercial |
$10,743.96
|
| Rate for Payer: Cofinity Commercial |
$1,749.02
|
| Rate for Payer: Healthscope Commercial |
$2,248.74
|
| Rate for Payer: Healthscope Commercial |
$11,243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,123.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,619.03
|
| Rate for Payer: PHP Commercial |
$10,619.03
|
| Rate for Payer: PHP Commercial |
$2,123.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,745.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.02
|
| Rate for Payer: Priority Health SBD |
$1,574.12
|
| Rate for Payer: Priority Health SBD |
$7,870.58
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,510.36
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.66 |
| Max. Negotiated Rate |
$2,259.32 |
| Rate for Payer: Aetna Commercial |
$2,133.81
|
| Rate for Payer: Aetna Commercial |
$10,669.03
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| 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: Allen County Amish Medical Aid Commercial |
$51.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.77
|
| Rate for Payer: BCBS Complete |
$23.79
|
| Rate for Payer: BCBS Complete |
$23.79
|
| Rate for Payer: BCBS MAPPO |
$41.42
|
| Rate for Payer: BCBS MAPPO |
$41.42
|
| Rate for Payer: BCBS Trust/PPO |
$111.20
|
| Rate for Payer: BCBS Trust/PPO |
$111.20
|
| Rate for Payer: BCN Medicare Advantage |
$41.42
|
| Rate for Payer: BCN Medicare Advantage |
$41.42
|
| 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: Cash Price |
$10,041.44
|
| Rate for Payer: Cofinity Commercial |
$10,794.55
|
| Rate for Payer: Cofinity Commercial |
$8,786.26
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Cofinity Commercial |
$1,757.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.42
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| Rate for Payer: Mclaren Medicaid |
$22.66
|
| Rate for Payer: Mclaren Medicaid |
$22.66
|
| Rate for Payer: Mclaren Medicare |
$41.42
|
| Rate for Payer: Mclaren Medicare |
$41.42
|
| Rate for Payer: Meridian Medicaid |
$23.79
|
| Rate for Payer: Meridian Medicaid |
$23.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,133.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,669.03
|
| Rate for Payer: PACE Medicare |
$39.35
|
| Rate for Payer: PACE Medicare |
$39.35
|
| Rate for Payer: PACE SWMI |
$41.42
|
| Rate for Payer: PACE SWMI |
$41.42
|
| Rate for Payer: PHP Commercial |
$10,669.03
|
| Rate for Payer: PHP Commercial |
$2,133.81
|
| Rate for Payer: PHP Medicare Advantage |
$41.42
|
| Rate for Payer: PHP Medicare Advantage |
$41.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,786.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.25
|
| Rate for Payer: Priority Health Medicare |
$41.42
|
| Rate for Payer: Priority Health Medicare |
$41.42
|
| Rate for Payer: Priority Health SBD |
$7,907.63
|
| Rate for Payer: Priority Health SBD |
$1,581.53
|
| Rate for Payer: Railroad Medicare Medicare |
$41.42
|
| Rate for Payer: Railroad Medicare Medicare |
$41.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.42
|
| Rate for Payer: UHC Medicare Advantage |
$42.66
|
| Rate for Payer: UHC Medicare Advantage |
$42.66
|
| Rate for Payer: VA VA |
$41.42
|
| Rate for Payer: VA VA |
$41.42
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,510.36
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,581.53 |
| Max. Negotiated Rate |
$2,259.32 |
| Rate for Payer: Aetna Commercial |
$2,133.81
|
| Rate for Payer: Aetna Commercial |
$10,669.03
|
| 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: Cash Price |
$10,041.44
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cofinity Commercial |
$10,794.55
|
| Rate for Payer: Cofinity Commercial |
$8,786.26
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Cofinity Commercial |
$1,757.25
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,133.81
|
| Rate for Payer: PHP Commercial |
$10,669.03
|
| Rate for Payer: PHP Commercial |
$2,133.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,757.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,786.26
|
| 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
|
OP
|
$11,924.32
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.18 |
| 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 |
$21.26
|
| Rate for Payer: Aetna Medicare |
$21.26
|
| 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: Allen County Amish Medical Aid Commercial |
$25.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.56
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: BCBS Complete |
$11.74
|
| Rate for Payer: BCBS MAPPO |
$20.45
|
| Rate for Payer: BCBS MAPPO |
$20.45
|
| Rate for Payer: BCBS Trust/PPO |
$59.97
|
| Rate for Payer: BCBS Trust/PPO |
$59.97
|
| Rate for Payer: BCN Medicare Advantage |
$20.45
|
| Rate for Payer: BCN Medicare Advantage |
$20.45
|
| 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 |
$8,347.02
|
| Rate for Payer: Cofinity Commercial |
$1,669.41
|
| Rate for Payer: Cofinity Commercial |
$10,254.92
|
| Rate for Payer: Cofinity Commercial |
$2,050.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.45
|
| Rate for Payer: Healthscope Commercial |
$10,731.89
|
| Rate for Payer: Healthscope Commercial |
$2,146.38
|
| Rate for Payer: Mclaren Medicaid |
$11.18
|
| Rate for Payer: Mclaren Medicaid |
$11.18
|
| Rate for Payer: Mclaren Medicare |
$20.45
|
| Rate for Payer: Mclaren Medicare |
$20.45
|
| Rate for Payer: Meridian Medicaid |
$11.74
|
| Rate for Payer: Meridian Medicaid |
$11.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,027.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,135.67
|
| Rate for Payer: PACE Medicare |
$19.42
|
| Rate for Payer: PACE Medicare |
$19.42
|
| Rate for Payer: PACE SWMI |
$20.45
|
| Rate for Payer: PACE SWMI |
$20.45
|
| Rate for Payer: PHP Commercial |
$10,135.67
|
| Rate for Payer: PHP Commercial |
$2,027.14
|
| Rate for Payer: PHP Medicare Advantage |
$20.45
|
| Rate for Payer: PHP Medicare Advantage |
$20.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,669.41
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health SBD |
$7,512.32
|
| Rate for Payer: Priority Health SBD |
$1,502.47
|
| Rate for Payer: Railroad Medicare Medicare |
$20.45
|
| Rate for Payer: Railroad Medicare Medicare |
$20.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.45
|
| Rate for Payer: UHC Medicare Advantage |
$21.06
|
| Rate for Payer: UHC Medicare Advantage |
$21.06
|
| Rate for Payer: VA VA |
$20.45
|
| Rate for Payer: VA VA |
$20.45
|
|
|
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 |
$1,907.90
|
| Rate for Payer: Cash Price |
$9,539.46
|
| Rate for Payer: Cofinity Commercial |
$8,347.02
|
| Rate for Payer: Cofinity Commercial |
$2,050.99
|
| Rate for Payer: Cofinity Commercial |
$1,669.41
|
| Rate for Payer: Cofinity Commercial |
$10,254.92
|
| Rate for Payer: Healthscope Commercial |
$2,146.38
|
| Rate for Payer: Healthscope Commercial |
$10,731.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,027.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,135.67
|
| Rate for Payer: PHP Commercial |
$2,027.14
|
| Rate for Payer: PHP Commercial |
$10,135.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,669.41
|
| Rate for Payer: Priority Health SBD |
$1,502.47
|
| Rate for Payer: Priority Health SBD |
$7,512.32
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 50458-580-10
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.75
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.98
|
| Rate for Payer: PHP Commercial |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health SBD |
$13.32
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 50458-580-01
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna Commercial |
$0.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.14
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Cofinity Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.19
|
| Rate for Payer: PHP Commercial |
$0.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.15
|
| Rate for Payer: Priority Health SBD |
$0.14
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.75
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Cofinity Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.98
|
| Rate for Payer: PHP Commercial |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health SBD |
$13.32
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 50458-578-30
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.40
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health SBD |
$4.00
|
|
