|
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 |
$5,496.91 |
| Max. Negotiated Rate |
$11,243.68 |
| Rate for Payer: Aetna American Axle |
$8,120.44
|
| Rate for Payer: Aetna Commercial |
$10,619.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,120.44
|
| Rate for Payer: Cash Price |
$9,994.38
|
| Rate for Payer: Cofinity Commercial |
$10,743.96
|
| Rate for Payer: Cofinity Commercial |
$8,745.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,994.38
|
| Rate for Payer: Healthscope Commercial |
$11,243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,745.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,369.74
|
| 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: Priority Health Cigna Priority Health |
$8,745.09
|
| Rate for Payer: Priority Health SBD |
$7,870.58
|
| Rate for Payer: UMR Bronson Commercial |
$5,496.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,369.74
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,498.60
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$2,248.74 |
| Rate for Payer: Aetna American Axle |
$1,624.09
|
| Rate for Payer: Aetna American Axle |
$8,120.44
|
| Rate for Payer: Aetna Commercial |
$2,123.81
|
| Rate for Payer: Aetna Commercial |
$10,619.03
|
| Rate for Payer: Aetna Medicare |
$37.33
|
| Rate for Payer: Aetna Medicare |
$37.33
|
| 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: Allen County Amish Medical Aid Commercial |
$44.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.86
|
| Rate for Payer: BCBS Complete |
$20.62
|
| Rate for Payer: BCBS Complete |
$20.62
|
| Rate for Payer: BCBS MAPPO |
$35.89
|
| Rate for Payer: BCBS MAPPO |
$35.89
|
| Rate for Payer: BCBS Trust/PPO |
$102.45
|
| Rate for Payer: BCBS Trust/PPO |
$102.45
|
| Rate for Payer: BCN Medicare Advantage |
$35.89
|
| Rate for Payer: BCN Medicare Advantage |
$35.89
|
| Rate for Payer: Cash Price |
$1,998.88
|
| Rate for Payer: Cash Price |
$1,998.88
|
| Rate for Payer: Cash Price |
$9,994.38
|
| Rate for Payer: Cash Price |
$9,994.38
|
| Rate for Payer: Cofinity Commercial |
$1,749.02
|
| Rate for Payer: Cofinity Commercial |
$2,148.80
|
| Rate for Payer: Cofinity Commercial |
$10,743.96
|
| Rate for Payer: Cofinity Commercial |
$8,745.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,998.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,994.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.89
|
| Rate for Payer: Healthscope Commercial |
$2,248.74
|
| Rate for Payer: Healthscope Commercial |
$11,243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,745.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,749.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,873.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,369.74
|
| Rate for Payer: Mclaren Medicaid |
$19.63
|
| Rate for Payer: Mclaren Medicaid |
$19.63
|
| Rate for Payer: Mclaren Medicare |
$35.89
|
| Rate for Payer: Mclaren Medicare |
$35.89
|
| Rate for Payer: Meridian Medicaid |
$20.62
|
| Rate for Payer: Meridian Medicaid |
$20.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,619.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,123.81
|
| Rate for Payer: PACE Medicare |
$34.10
|
| Rate for Payer: PACE Medicare |
$34.10
|
| Rate for Payer: PACE SWMI |
$35.89
|
| Rate for Payer: PACE SWMI |
$35.89
|
| Rate for Payer: PHP Commercial |
$10,619.03
|
| Rate for Payer: PHP Commercial |
$2,123.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.89
|
| Rate for Payer: PHP Medicare Advantage |
$35.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.63
|
| 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 HMO/PPO/Tiered Network |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$35.89
|
| Rate for Payer: Priority Health Medicare |
$35.89
|
| Rate for Payer: Priority Health Narrow Network |
$88.40
|
| Rate for Payer: Priority Health Narrow Network |
$88.40
|
| Rate for Payer: Priority Health SBD |
$7,870.58
|
| Rate for Payer: Priority Health SBD |
$1,574.12
|
| Rate for Payer: Railroad Medicare Medicare |
$35.89
|
| Rate for Payer: Railroad Medicare Medicare |
$35.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.89
|
| Rate for Payer: UHC Medicare Advantage |
$36.97
|
| Rate for Payer: UHC Medicare Advantage |
$36.97
|
| Rate for Payer: UMR Bronson Commercial |
$4,622.40
|
| Rate for Payer: UMR Bronson Commercial |
$924.48
|
| Rate for Payer: VA VA |
$35.89
|
| Rate for Payer: VA VA |
$35.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,369.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,873.95
|
|
|
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 |
$1,104.56 |
| Max. Negotiated Rate |
$2,259.32 |
| Rate for Payer: Aetna American Axle |
$1,631.73
|
| Rate for Payer: Aetna American Axle |
$8,158.67
|
| 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 Commercial |
$8,786.26
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Cofinity Commercial |
$1,757.25
|
| 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: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,786.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,757.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,413.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,882.77
|
| 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: 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 |
$1,581.53
|
| Rate for Payer: Priority Health SBD |
$7,907.63
|
| Rate for Payer: UMR Bronson Commercial |
$5,522.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,104.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,413.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.77
|
|
|
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 |
$22.66 |
| Max. Negotiated Rate |
$11,296.62 |
| Rate for Payer: Aetna American Axle |
$8,158.67
|
| Rate for Payer: Aetna American Axle |
$1,631.73
|
| Rate for Payer: Aetna Commercial |
$10,669.03
|
| Rate for Payer: Aetna Commercial |
$2,133.81
|
| 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 |
$121.38
|
| Rate for Payer: BCBS Trust/PPO |
$121.38
|
| 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 |
$10,041.44
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cofinity Commercial |
$1,757.25
|
| 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: Encore Health Key Benefits Commercial |
$2,008.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,041.44
|
| 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 |
$2,259.32
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,757.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,786.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,413.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,882.77
|
| 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 |
$10,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,133.81
|
| 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 HMO/PPO/Tiered Network |
$127.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.67
|
| Rate for Payer: Priority Health Medicare |
$41.42
|
| Rate for Payer: Priority Health Medicare |
$41.42
|
| Rate for Payer: Priority Health Narrow Network |
$102.14
|
| Rate for Payer: Priority Health Narrow Network |
$102.14
|
| 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: UMR Bronson Commercial |
$4,644.17
|
| Rate for Payer: UMR Bronson Commercial |
$928.83
|
| Rate for Payer: VA VA |
$41.42
|
| Rate for Payer: VA VA |
$41.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,413.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.77
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,384.87
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,049.34 |
| Max. Negotiated Rate |
$2,146.38 |
| Rate for Payer: Aetna American Axle |
$1,550.17
|
| Rate for Payer: Aetna American Axle |
$7,750.81
|
| 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 |
$2,050.99
|
| Rate for Payer: Cofinity Commercial |
$10,254.92
|
| Rate for Payer: Cofinity Commercial |
$8,347.02
|
| Rate for Payer: Cofinity Commercial |
$1,669.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,907.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,539.46
|
| Rate for Payer: Healthscope Commercial |
$10,731.89
|
| Rate for Payer: Healthscope Commercial |
$2,146.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,347.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,669.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,788.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,943.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10,135.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$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 |
$8,347.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,669.41
|
| Rate for Payer: Priority Health SBD |
$7,512.32
|
| Rate for Payer: Priority Health SBD |
$1,502.47
|
| Rate for Payer: UMR Bronson Commercial |
$5,246.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,049.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,788.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,943.24
|
|
|
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 American Axle |
$7,750.81
|
| Rate for Payer: Aetna American Axle |
$1,550.17
|
| 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 |
$65.46
|
| Rate for Payer: BCBS Trust/PPO |
$65.46
|
| Rate for Payer: BCN Medicare Advantage |
$20.45
|
| Rate for Payer: BCN Medicare Advantage |
$20.45
|
| Rate for Payer: Cash Price |
$9,539.46
|
| Rate for Payer: Cash Price |
$9,539.46
|
| Rate for Payer: Cash Price |
$1,907.90
|
| Rate for Payer: Cash Price |
$1,907.90
|
| 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 Commercial |
$10,254.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,907.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,539.46
|
| 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 |
$2,146.38
|
| Rate for Payer: Healthscope Commercial |
$10,731.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,669.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,347.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,788.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,943.24
|
| 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 |
$2,027.14
|
| Rate for Payer: PHP Commercial |
$10,135.67
|
| 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 |
$1,669.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,347.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.49
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$20.45
|
| Rate for Payer: Priority Health Narrow Network |
$52.39
|
| Rate for Payer: Priority Health Narrow Network |
$52.39
|
| Rate for Payer: Priority Health SBD |
$1,502.47
|
| Rate for Payer: Priority Health SBD |
$7,512.32
|
| 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: UMR Bronson Commercial |
$4,412.00
|
| Rate for Payer: UMR Bronson Commercial |
$882.40
|
| Rate for Payer: VA VA |
$20.45
|
| Rate for Payer: VA VA |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,788.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,943.24
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| 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: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
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 |
$2.79 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| 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: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
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 |
$9.31 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna American Axle |
$13.75
|
| 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: Encore Health Key Benefits Commercial |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 50458-578-01
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna American Axle |
$0.14
|
| 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: Encore Health Key Benefits Commercial |
$0.18
|
| Rate for Payer: Healthscope Commercial |
$0.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.17
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.17
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 50458-579-01
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna American Axle |
$0.14
|
| 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: Encore Health Key Benefits Commercial |
$0.18
|
| Rate for Payer: Healthscope Commercial |
$0.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.17
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.17
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 50458-579-30
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| 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: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 50458-579-10
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna American Axle |
$13.75
|
| 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: Encore Health Key Benefits Commercial |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 50458-577-01
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Aetna American Axle |
$0.14
|
| 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: Encore Health Key Benefits Commercial |
$0.18
|
| Rate for Payer: Healthscope Commercial |
$0.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.17
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$0.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.17
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$12.69
|
|
|
Service Code
|
NDC 50458-577-60
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Aetna American Axle |
$8.25
|
| Rate for Payer: Aetna Commercial |
$10.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.25
|
| Rate for Payer: Cash Price |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.15
|
| Rate for Payer: Healthscope Commercial |
$11.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.79
|
| Rate for Payer: PHP Commercial |
$10.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.88
|
| Rate for Payer: Priority Health SBD |
$7.99
|
| Rate for Payer: UMR Bronson Commercial |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.52
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 50458-577-10
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna American Axle |
$13.75
|
| 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: Encore Health Key Benefits Commercial |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,170.83
|
|
|
Service Code
|
NDC 47781-405-03
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$515.17 |
| Max. Negotiated Rate |
$1,053.75 |
| Rate for Payer: Aetna American Axle |
$761.04
|
| Rate for Payer: Aetna Commercial |
$995.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.04
|
| Rate for Payer: Cash Price |
$936.66
|
| Rate for Payer: Cofinity Commercial |
$1,006.91
|
| Rate for Payer: Cofinity Commercial |
$819.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.66
|
| Rate for Payer: Healthscope Commercial |
$1,053.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$995.21
|
| Rate for Payer: PHP Commercial |
$995.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.58
|
| Rate for Payer: Priority Health SBD |
$737.62
|
| Rate for Payer: UMR Bronson Commercial |
$515.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.12
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$39.03
|
|
|
Service Code
|
NDC 47781-405-11
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna American Axle |
$25.37
|
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.37
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$27.32
|
| Rate for Payer: Cofinity Commercial |
$33.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.18
|
| Rate for Payer: PHP Commercial |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.32
|
| Rate for Payer: Priority Health SBD |
$24.59
|
| Rate for Payer: UMR Bronson Commercial |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.27
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$127.68
|
|
|
Service Code
|
NDC 65862-648-60
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Aetna American Axle |
$82.99
|
| Rate for Payer: Aetna Commercial |
$108.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.99
|
| Rate for Payer: Cash Price |
$102.14
|
| Rate for Payer: Cofinity Commercial |
$109.80
|
| Rate for Payer: Cofinity Commercial |
$89.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.14
|
| Rate for Payer: Healthscope Commercial |
$114.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.53
|
| Rate for Payer: PHP Commercial |
$108.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.38
|
| Rate for Payer: Priority Health SBD |
$80.44
|
| Rate for Payer: UMR Bronson Commercial |
$56.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.76
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$148.32
|
|
|
Service Code
|
NDC 55111-352-60
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.26 |
| Max. Negotiated Rate |
$133.49 |
| Rate for Payer: Aetna American Axle |
$96.41
|
| Rate for Payer: Aetna Commercial |
$126.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.41
|
| Rate for Payer: Cash Price |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Cofinity Commercial |
$127.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.66
|
| Rate for Payer: Healthscope Commercial |
$133.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.07
|
| Rate for Payer: PHP Commercial |
$126.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.82
|
| Rate for Payer: Priority Health SBD |
$93.44
|
| Rate for Payer: UMR Bronson Commercial |
$65.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.24
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$170.43
|
|
|
Service Code
|
NDC 65862-649-60
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$153.39 |
| Rate for Payer: Aetna American Axle |
$110.78
|
| Rate for Payer: Aetna Commercial |
$144.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.78
|
| Rate for Payer: Cash Price |
$136.34
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Cofinity Commercial |
$146.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.34
|
| Rate for Payer: Healthscope Commercial |
$153.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.87
|
| Rate for Payer: PHP Commercial |
$144.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.30
|
| Rate for Payer: Priority Health SBD |
$107.37
|
| Rate for Payer: UMR Bronson Commercial |
$74.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.82
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$156.39
|
|
|
Service Code
|
NDC 62756-146-86
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.81 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.93
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.47
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UMR Bronson Commercial |
$68.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$148.32
|
|
|
Service Code
|
NDC 55111-353-60
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.26 |
| Max. Negotiated Rate |
$133.49 |
| Rate for Payer: Aetna American Axle |
$96.41
|
| Rate for Payer: Aetna Commercial |
$126.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.41
|
| Rate for Payer: Cash Price |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$103.82
|
| Rate for Payer: Cofinity Commercial |
$127.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.66
|
| Rate for Payer: Healthscope Commercial |
$133.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.07
|
| Rate for Payer: PHP Commercial |
$126.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.82
|
| Rate for Payer: Priority Health SBD |
$93.44
|
| Rate for Payer: UMR Bronson Commercial |
$65.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.24
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.69
|
|
|
Service Code
|
NDC 0078-0501-61
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna American Axle |
$51.15
|
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.95
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health SBD |
$49.57
|
| Rate for Payer: UMR Bronson Commercial |
$34.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,360.53
|
|
|
Service Code
|
NDC 0078-0501-15
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,038.63 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna American Axle |
$1,534.34
|
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.34
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$1,652.37
|
| Rate for Payer: Cofinity Commercial |
$2,030.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.42
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,652.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,652.37
|
| Rate for Payer: Priority Health SBD |
$1,487.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,038.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
