|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$190.99
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.04 |
| Max. Negotiated Rate |
$171.89 |
| Rate for Payer: Aetna American Axle |
$124.14
|
| Rate for Payer: Aetna Commercial |
$162.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.14
|
| Rate for Payer: Cash Price |
$152.79
|
| Rate for Payer: Cofinity Advantage |
$133.69
|
| Rate for Payer: Cofinity Commercial |
$164.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.79
|
| Rate for Payer: Healthscope Commercial |
$171.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.24
|
| Rate for Payer: PHP Commercial |
$162.34
|
| Rate for Payer: Priority Health SBD |
$120.32
|
| Rate for Payer: UMR Bronson Commercial |
$84.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.24
|
|
|
RISPERIDONE 3 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$190.99
|
|
|
Service Code
|
NDC 59746004022
|
| Hospital Charge Code |
70257
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.67 |
| Max. Negotiated Rate |
$171.89 |
| Rate for Payer: Aetna American Axle |
$124.14
|
| Rate for Payer: Aetna Commercial |
$162.34
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.14
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: Cash Price |
$152.79
|
| Rate for Payer: Cofinity Advantage |
$133.69
|
| Rate for Payer: Cofinity Commercial |
$164.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.79
|
| Rate for Payer: Healthscope Commercial |
$171.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.24
|
| Rate for Payer: PHP Commercial |
$162.34
|
| Rate for Payer: Priority Health SBD |
$120.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.14
|
| Rate for Payer: UHC Core |
$99.51
|
| Rate for Payer: UHC Exchange |
$75.06
|
| Rate for Payer: UMR Bronson Commercial |
$70.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.24
|
|
|
RISPERIDONE ER 120 MG SUBCUTANEOUS EXTENDED RELEASE SUSPENSION SYRINGE
|
Facility
|
OP
|
$7,009.40
|
|
|
Service Code
|
HCPCS J2798
|
| Hospital Charge Code |
188120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$6,308.46 |
| Rate for Payer: Aetna American Axle |
$4,556.11
|
| Rate for Payer: Aetna Commercial |
$5,957.99
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,556.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.21
|
| Rate for Payer: BCBS Complete |
$6.68
|
| Rate for Payer: BCBS MAPPO |
$12.17
|
| Rate for Payer: BCBS Trust/PPO |
$39.34
|
| Rate for Payer: BCN Commercial |
$39.34
|
| Rate for Payer: BCN Medicare Advantage |
$12.17
|
| Rate for Payer: Cash Price |
$5,607.52
|
| Rate for Payer: Cash Price |
$5,607.52
|
| Rate for Payer: Cofinity Advantage |
$4,906.58
|
| Rate for Payer: Cofinity Commercial |
$6,028.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,607.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$6,308.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,906.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,257.05
|
| Rate for Payer: Mclaren Medicaid |
$12.17
|
| Rate for Payer: Mclaren Medicare |
$12.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.78
|
| Rate for Payer: Meridian Medicaid |
$12.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,957.99
|
| Rate for Payer: Nomi Health Commercial |
$36.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,257.05
|
| Rate for Payer: PACE Medicare |
$11.56
|
| Rate for Payer: PACE SWMI |
$12.17
|
| Rate for Payer: PHP Commercial |
$5,957.99
|
| Rate for Payer: PHP Medicare Advantage |
$12.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.29
|
| Rate for Payer: Priority Health Medicare |
$12.17
|
| Rate for Payer: Priority Health SBD |
$4,415.92
|
| Rate for Payer: Priority Health Tiered Network |
$30.63
|
| Rate for Payer: Railroad Medicare Medicare |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.17
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicaid |
$6.36
|
| Rate for Payer: UHCCP Medicaid |
$6.36
|
| Rate for Payer: UMR Bronson Commercial |
$2,593.48
|
| Rate for Payer: VA VA |
$12.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,257.05
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
IP
|
$1,881.96
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$828.06 |
| Max. Negotiated Rate |
$1,693.76 |
| Rate for Payer: Aetna American Axle |
$1,223.27
|
| Rate for Payer: Aetna Commercial |
$1,599.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,223.27
|
| Rate for Payer: Cash Price |
$1,505.57
|
| Rate for Payer: Cofinity Advantage |
$1,317.37
|
| Rate for Payer: Cofinity Commercial |
$1,618.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,505.57
|
| Rate for Payer: Healthscope Commercial |
$1,693.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,317.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,411.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,599.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,411.47
|
| Rate for Payer: PHP Commercial |
$1,599.67
|
| Rate for Payer: Priority Health SBD |
$1,185.63
|
| Rate for Payer: UMR Bronson Commercial |
$828.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,411.47
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
OP
|
$1,354.60
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$1,219.14 |
| Rate for Payer: Aetna American Axle |
$880.49
|
| Rate for Payer: Aetna American Axle |
$1,223.27
|
| Rate for Payer: Aetna Commercial |
$1,151.41
|
| Rate for Payer: Aetna Commercial |
$1,599.67
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$880.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,223.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.25
|
| Rate for Payer: BCBS Trust/PPO |
$36.25
|
| Rate for Payer: BCN Commercial |
$36.25
|
| Rate for Payer: BCN Commercial |
$36.25
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$1,505.57
|
| Rate for Payer: Cash Price |
$1,083.68
|
| Rate for Payer: Cash Price |
$1,083.68
|
| Rate for Payer: Cash Price |
$1,505.57
|
| Rate for Payer: Cofinity Advantage |
$1,317.37
|
| Rate for Payer: Cofinity Advantage |
$948.22
|
| Rate for Payer: Cofinity Commercial |
$1,164.96
|
| Rate for Payer: Cofinity Commercial |
$1,618.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,505.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,083.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$1,219.14
|
| Rate for Payer: Healthscope Commercial |
$1,693.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$948.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,317.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,411.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,015.95
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,599.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,151.41
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,015.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,411.47
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$1,151.41
|
| Rate for Payer: PHP Commercial |
$1,599.67
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.63
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health SBD |
$1,185.63
|
| Rate for Payer: Priority Health SBD |
$853.40
|
| Rate for Payer: Priority Health Tiered Network |
$27.70
|
| Rate for Payer: Priority Health Tiered Network |
$27.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.45
|
| Rate for Payer: UHC Core |
$18.45
|
| Rate for Payer: UHC Core |
$18.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Medicaid |
$5.65
|
| Rate for Payer: UHC Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$501.20
|
| Rate for Payer: UMR Bronson Commercial |
$696.33
|
| Rate for Payer: VA VA |
$10.80
|
| Rate for Payer: VA VA |
$10.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,015.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,411.47
|
|
|
RISPERIDONE MICROSPHERES ER 37.5 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEAS
|
Facility
|
OP
|
$2,823.08
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$2,540.77 |
| Rate for Payer: Aetna American Axle |
$1,835.00
|
| Rate for Payer: Aetna Commercial |
$2,399.62
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,835.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.25
|
| Rate for Payer: BCN Commercial |
$36.25
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$2,258.46
|
| Rate for Payer: Cash Price |
$2,258.46
|
| Rate for Payer: Cofinity Advantage |
$1,976.16
|
| Rate for Payer: Cofinity Commercial |
$2,427.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,258.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$2,540.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,976.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,117.31
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,399.62
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,117.31
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$2,399.62
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.63
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health SBD |
$1,778.54
|
| Rate for Payer: Priority Health Tiered Network |
$27.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.45
|
| Rate for Payer: UHC Core |
$18.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,044.54
|
| Rate for Payer: VA VA |
$10.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,117.31
|
|
|
RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
IP
|
$3,764.23
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,656.26 |
| Max. Negotiated Rate |
$3,387.81 |
| Rate for Payer: Aetna American Axle |
$2,446.75
|
| Rate for Payer: Aetna Commercial |
$3,199.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.75
|
| Rate for Payer: Cash Price |
$3,011.38
|
| Rate for Payer: Cofinity Advantage |
$2,634.96
|
| Rate for Payer: Cofinity Commercial |
$3,237.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,011.38
|
| Rate for Payer: Healthscope Commercial |
$3,387.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,823.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,199.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,823.17
|
| Rate for Payer: PHP Commercial |
$3,199.60
|
| Rate for Payer: Priority Health SBD |
$2,371.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,656.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,823.17
|
|
|
RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
OP
|
$3,764.23
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$3,387.81 |
| Rate for Payer: Aetna American Axle |
$2,446.75
|
| Rate for Payer: Aetna Commercial |
$3,199.60
|
| Rate for Payer: Aetna Medicare |
$11.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.50
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$36.25
|
| Rate for Payer: BCN Commercial |
$36.25
|
| Rate for Payer: BCN Medicare Advantage |
$10.80
|
| Rate for Payer: Cash Price |
$3,011.38
|
| Rate for Payer: Cash Price |
$3,011.38
|
| Rate for Payer: Cofinity Advantage |
$2,634.96
|
| Rate for Payer: Cofinity Commercial |
$3,237.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,011.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$3,387.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,634.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,823.17
|
| Rate for Payer: Mclaren Medicaid |
$10.80
|
| Rate for Payer: Mclaren Medicare |
$10.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.34
|
| Rate for Payer: Meridian Medicaid |
$11.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,199.60
|
| Rate for Payer: Nomi Health Commercial |
$32.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,823.17
|
| Rate for Payer: PACE Medicare |
$10.26
|
| Rate for Payer: PACE SWMI |
$10.80
|
| Rate for Payer: PHP Commercial |
$3,199.60
|
| Rate for Payer: PHP Medicare Advantage |
$10.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.63
|
| Rate for Payer: Priority Health Medicare |
$10.80
|
| Rate for Payer: Priority Health SBD |
$2,371.46
|
| Rate for Payer: Priority Health Tiered Network |
$27.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.45
|
| Rate for Payer: UHC Core |
$18.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.80
|
| Rate for Payer: UHC Exchange |
$18.45
|
| Rate for Payer: UHC Medicaid |
$5.65
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,392.77
|
| Rate for Payer: VA VA |
$10.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,823.17
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
OP
|
$927.74
|
|
|
Service Code
|
NDC 00074333330
|
| Hospital Charge Code |
100995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.26 |
| Max. Negotiated Rate |
$834.97 |
| Rate for Payer: Aetna American Axle |
$603.03
|
| 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 Advantage |
$649.42
|
| Rate for Payer: Cofinity Commercial |
$797.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.19
|
| Rate for Payer: Healthscope Commercial |
$834.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$742.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.80
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health SBD |
$584.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.03
|
| Rate for Payer: UHC Core |
$483.35
|
| Rate for Payer: UHC Exchange |
$364.60
|
| Rate for Payer: UMR Bronson Commercial |
$343.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.80
|
|
|
RITONAVIR 100 MG TABLET
|
Facility
|
IP
|
$927.74
|
|
|
Service Code
|
NDC 00074333330
|
| Hospital Charge Code |
100995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$408.21 |
| Max. Negotiated Rate |
$834.97 |
| Rate for Payer: Aetna American Axle |
$603.03
|
| 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 Advantage |
$649.42
|
| Rate for Payer: Cofinity Commercial |
$797.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.19
|
| Rate for Payer: Healthscope Commercial |
$834.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$649.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.80
|
| Rate for Payer: PHP Commercial |
$788.58
|
| Rate for Payer: Priority Health SBD |
$584.48
|
| Rate for Payer: UMR Bronson Commercial |
$408.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.80
|
|
|
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 |
$9,280.58 |
| Max. Negotiated Rate |
$18,983.01 |
| Rate for Payer: Aetna American Axle |
$13,709.95
|
| Rate for Payer: Aetna American Axle |
$2,741.99
|
| 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 Advantage |
$2,952.91
|
| Rate for Payer: Cofinity Advantage |
$14,764.56
|
| Rate for Payer: Cofinity Commercial |
$3,627.87
|
| Rate for Payer: Cofinity Commercial |
$18,139.32
|
| 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 |
$3,796.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,952.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,764.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,819.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,163.84
|
| 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: Opus (Opus Packaging Group) HMA |
$15,819.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,163.84
|
| Rate for Payer: PHP Commercial |
$17,928.40
|
| Rate for Payer: PHP Commercial |
$3,585.68
|
| Rate for Payer: Priority Health SBD |
$2,657.62
|
| Rate for Payer: Priority Health SBD |
$13,288.10
|
| Rate for Payer: UMR Bronson Commercial |
$9,280.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,856.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,819.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,163.84
|
|
|
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 |
$38.79 |
| Max. Negotiated Rate |
$3,796.61 |
| Rate for Payer: Aetna American Axle |
$2,741.99
|
| Rate for Payer: Aetna American Axle |
$13,709.95
|
| Rate for Payer: Aetna Commercial |
$17,928.40
|
| Rate for Payer: Aetna Commercial |
$3,585.68
|
| Rate for Payer: Aetna Medicare |
$77.13
|
| Rate for Payer: Aetna Medicare |
$77.13
|
| 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: Allen County Amish Medical Aid Commercial |
$92.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.70
|
| Rate for Payer: BCBS Complete |
$40.73
|
| Rate for Payer: BCBS Complete |
$40.73
|
| Rate for Payer: BCBS MAPPO |
$74.16
|
| Rate for Payer: BCBS MAPPO |
$74.16
|
| Rate for Payer: BCBS Trust/PPO |
$242.42
|
| Rate for Payer: BCBS Trust/PPO |
$242.42
|
| Rate for Payer: BCN Commercial |
$242.42
|
| Rate for Payer: BCN Commercial |
$242.42
|
| Rate for Payer: BCN Medicare Advantage |
$74.16
|
| Rate for Payer: BCN Medicare Advantage |
$74.16
|
| 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: Cash Price |
$16,873.78
|
| Rate for Payer: Cofinity Advantage |
$2,952.91
|
| Rate for Payer: Cofinity Advantage |
$14,764.56
|
| Rate for Payer: Cofinity Commercial |
$18,139.32
|
| Rate for Payer: Cofinity Commercial |
$3,627.87
|
| 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: Health Alliance Plan Medicare Advantage |
$74.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.16
|
| Rate for Payer: Healthscope Commercial |
$18,983.01
|
| Rate for Payer: Healthscope Commercial |
$3,796.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,952.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,764.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,819.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,163.84
|
| Rate for Payer: Mclaren Medicaid |
$74.16
|
| Rate for Payer: Mclaren Medicaid |
$74.16
|
| Rate for Payer: Mclaren Medicare |
$74.16
|
| Rate for Payer: Mclaren Medicare |
$74.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.87
|
| Rate for Payer: Meridian Medicaid |
$77.87
|
| Rate for Payer: Meridian Medicaid |
$77.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.58
|
| 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 |
$222.48
|
| Rate for Payer: Nomi Health Commercial |
$222.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,163.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,819.17
|
| Rate for Payer: PACE Medicare |
$70.45
|
| Rate for Payer: PACE Medicare |
$70.45
|
| Rate for Payer: PACE SWMI |
$74.16
|
| Rate for Payer: PACE SWMI |
$74.16
|
| Rate for Payer: PHP Commercial |
$17,928.40
|
| Rate for Payer: PHP Commercial |
$3,585.68
|
| Rate for Payer: PHP Medicare Advantage |
$74.16
|
| Rate for Payer: PHP Medicare Advantage |
$74.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$237.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$237.23
|
| Rate for Payer: Priority Health Medicare |
$74.16
|
| Rate for Payer: Priority Health Medicare |
$74.16
|
| Rate for Payer: Priority Health SBD |
$13,288.10
|
| Rate for Payer: Priority Health SBD |
$2,657.62
|
| Rate for Payer: Priority Health Tiered Network |
$189.78
|
| Rate for Payer: Priority Health Tiered Network |
$189.78
|
| Rate for Payer: Railroad Medicare Medicare |
$74.16
|
| Rate for Payer: Railroad Medicare Medicare |
$74.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.37
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: UHC Core |
$123.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.16
|
| Rate for Payer: UHC Exchange |
$123.37
|
| Rate for Payer: UHC Exchange |
$123.37
|
| Rate for Payer: UHC Medicaid |
$38.79
|
| Rate for Payer: UHC Medicaid |
$38.79
|
| Rate for Payer: UHCCP Medicaid |
$38.79
|
| Rate for Payer: UHCCP Medicaid |
$38.79
|
| Rate for Payer: UMR Bronson Commercial |
$7,804.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,560.83
|
| Rate for Payer: VA VA |
$74.16
|
| Rate for Payer: VA VA |
$74.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,163.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,819.17
|
|
|
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 |
$18.97 |
| Max. Negotiated Rate |
$15,389.21 |
| Rate for Payer: Aetna American Axle |
$11,114.43
|
| Rate for Payer: Aetna Commercial |
$14,534.25
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,114.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.35
|
| Rate for Payer: BCBS Complete |
$19.92
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS Trust/PPO |
$119.54
|
| Rate for Payer: BCN Commercial |
$119.54
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cash Price |
$13,679.30
|
| Rate for Payer: Cofinity Advantage |
$11,969.38
|
| Rate for Payer: Cofinity Commercial |
$14,705.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,679.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$15,389.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,969.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,824.34
|
| Rate for Payer: Mclaren Medicaid |
$36.28
|
| Rate for Payer: Mclaren Medicare |
$36.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Medicaid |
$38.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,534.25
|
| Rate for Payer: Nomi Health Commercial |
$108.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,824.34
|
| Rate for Payer: PACE Medicare |
$34.47
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Commercial |
$14,534.25
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.73
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health SBD |
$10,772.45
|
| Rate for Payer: Priority Health Tiered Network |
$92.58
|
| Rate for Payer: Railroad Medicare Medicare |
$36.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.84
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.28
|
| Rate for Payer: UHC Exchange |
$60.84
|
| Rate for Payer: UHC Medicaid |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$18.97
|
| Rate for Payer: UMR Bronson Commercial |
$6,326.67
|
| Rate for Payer: VA VA |
$36.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,824.34
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN
|
Facility
|
OP
|
$19,541.83
|
|
|
Service Code
|
HCPCS J9311
|
| Hospital Charge Code |
183627
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$17,587.65 |
| Rate for Payer: Aetna American Axle |
$12,702.19
|
| Rate for Payer: Aetna Commercial |
$16,610.56
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,702.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.35
|
| Rate for Payer: BCBS Complete |
$19.92
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS Trust/PPO |
$119.54
|
| Rate for Payer: BCN Commercial |
$119.54
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$15,633.46
|
| Rate for Payer: Cash Price |
$15,633.46
|
| Rate for Payer: Cofinity Advantage |
$13,679.28
|
| Rate for Payer: Cofinity Commercial |
$16,805.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,633.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Healthscope Commercial |
$17,587.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,679.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,656.37
|
| Rate for Payer: Mclaren Medicaid |
$36.28
|
| Rate for Payer: Mclaren Medicare |
$36.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Medicaid |
$38.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,610.56
|
| Rate for Payer: Nomi Health Commercial |
$108.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,656.37
|
| Rate for Payer: PACE Medicare |
$34.47
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Commercial |
$16,610.56
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.73
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health SBD |
$12,311.35
|
| Rate for Payer: Priority Health Tiered Network |
$92.58
|
| Rate for Payer: Railroad Medicare Medicare |
$36.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.84
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36.28
|
| Rate for Payer: UHC Exchange |
$60.84
|
| Rate for Payer: UHC Medicaid |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$18.97
|
| Rate for Payer: UMR Bronson Commercial |
$7,230.48
|
| Rate for Payer: VA VA |
$36.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,656.37
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$2,398.66 |
| Rate for Payer: Aetna American Axle |
$1,732.37
|
| Rate for Payer: Aetna American Axle |
$8,661.82
|
| Rate for Payer: Aetna Commercial |
$11,327.00
|
| Rate for Payer: Aetna Commercial |
$2,265.40
|
| Rate for Payer: Aetna Medicare |
$32.53
|
| Rate for Payer: Aetna Medicare |
$32.53
|
| 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: Allen County Amish Medical Aid Commercial |
$39.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.10
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS Complete |
$17.18
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$139.65
|
| Rate for Payer: BCBS Trust/PPO |
$139.65
|
| Rate for Payer: BCN Commercial |
$139.65
|
| Rate for Payer: BCN Commercial |
$139.65
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: Cash Price |
$10,660.70
|
| 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: Cofinity Advantage |
$1,865.63
|
| Rate for Payer: Cofinity Advantage |
$9,328.12
|
| Rate for Payer: Cofinity Commercial |
$11,460.26
|
| Rate for Payer: Cofinity Commercial |
$2,292.05
|
| 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 |
$31.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$11,993.29
|
| Rate for Payer: Healthscope Commercial |
$2,398.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,865.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,328.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,994.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,998.88
|
| Rate for Payer: Mclaren Medicaid |
$31.28
|
| Rate for Payer: Mclaren Medicaid |
$31.28
|
| Rate for Payer: Mclaren Medicare |
$31.28
|
| Rate for Payer: Mclaren Medicare |
$31.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: Meridian Medicaid |
$32.84
|
| Rate for Payer: Meridian Medicaid |
$32.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.41
|
| 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: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Nomi Health Commercial |
$93.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,994.41
|
| Rate for Payer: PACE Medicare |
$29.72
|
| Rate for Payer: PACE Medicare |
$29.72
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PHP Commercial |
$11,327.00
|
| Rate for Payer: PHP Commercial |
$2,265.40
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.67
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health SBD |
$8,395.30
|
| Rate for Payer: Priority Health SBD |
$1,679.06
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Priority Health Tiered Network |
$74.14
|
| Rate for Payer: Railroad Medicare Medicare |
$31.28
|
| Rate for Payer: Railroad Medicare Medicare |
$31.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.75
|
| Rate for Payer: UHC Core |
$49.75
|
| Rate for Payer: UHC Core |
$49.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.28
|
| Rate for Payer: UHC Exchange |
$49.75
|
| Rate for Payer: UHC Exchange |
$49.75
|
| Rate for Payer: UHC Medicaid |
$16.36
|
| Rate for Payer: UHC Medicaid |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$4,930.58
|
| Rate for Payer: UMR Bronson Commercial |
$986.12
|
| Rate for Payer: VA VA |
$31.28
|
| Rate for Payer: VA VA |
$31.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,998.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,994.41
|
|
|
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 |
$5,863.39 |
| Max. Negotiated Rate |
$11,993.29 |
| Rate for Payer: Aetna American Axle |
$8,661.82
|
| Rate for Payer: Aetna American Axle |
$1,732.37
|
| 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 Advantage |
$1,865.63
|
| Rate for Payer: Cofinity Advantage |
$9,328.12
|
| Rate for Payer: Cofinity Commercial |
$2,292.05
|
| Rate for Payer: Cofinity Commercial |
$11,460.26
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,865.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,328.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,994.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,998.88
|
| 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: Opus (Opus Packaging Group) HMA |
$9,994.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.88
|
| Rate for Payer: PHP Commercial |
$11,327.00
|
| Rate for Payer: PHP Commercial |
$2,265.40
|
| Rate for Payer: Priority Health SBD |
$1,679.06
|
| Rate for Payer: Priority Health SBD |
$8,395.30
|
| Rate for Payer: UMR Bronson Commercial |
$5,863.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,994.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,998.88
|
|
|
RITUXIMAB-ARRX 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,551.80
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,522.79 |
| 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 New Business (MI Preferred) |
$8,158.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.73
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cofinity Advantage |
$1,757.25
|
| Rate for Payer: Cofinity Advantage |
$8,786.26
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Cofinity Commercial |
$10,794.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,041.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.29
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| 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: Multiplan/Beech St/PHCS Commercial |
$10,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,413.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,882.77
|
| Rate for Payer: PHP Commercial |
$10,669.03
|
| Rate for Payer: PHP Commercial |
$2,133.81
|
| Rate for Payer: Priority Health SBD |
$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
|
$2,510.36
|
|
|
Service Code
|
HCPCS Q5123
|
| Hospital Charge Code |
195768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.60 |
| 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 Medicare |
$21.07
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| 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 |
$25.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.32
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS Complete |
$11.13
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$136.18
|
| Rate for Payer: BCBS Trust/PPO |
$136.18
|
| Rate for Payer: BCN Commercial |
$136.18
|
| Rate for Payer: BCN Commercial |
$136.18
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cash Price |
$2,008.29
|
| Rate for Payer: Cash Price |
$10,041.44
|
| Rate for Payer: Cofinity Advantage |
$1,757.25
|
| Rate for Payer: Cofinity Advantage |
$8,786.26
|
| Rate for Payer: Cofinity Commercial |
$10,794.55
|
| Rate for Payer: Cofinity Commercial |
$2,158.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,041.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,008.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$11,296.62
|
| Rate for Payer: Healthscope Commercial |
$2,259.32
|
| Rate for Payer: 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 |
$20.26
|
| Rate for Payer: Mclaren Medicaid |
$20.26
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Mclaren Medicare |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$21.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,133.81
|
| Rate for Payer: Nomi Health Commercial |
$60.78
|
| Rate for Payer: Nomi Health Commercial |
$60.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,882.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9,413.85
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE Medicare |
$19.25
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$10,669.03
|
| Rate for Payer: PHP Commercial |
$2,133.81
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$83.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$83.61
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$7,907.63
|
| Rate for Payer: Priority Health SBD |
$1,581.53
|
| Rate for Payer: Priority Health Tiered Network |
$66.89
|
| Rate for Payer: Priority Health Tiered Network |
$66.89
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.49
|
| Rate for Payer: UHC Core |
$34.49
|
| Rate for Payer: UHC Core |
$34.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Exchange |
$34.49
|
| Rate for Payer: UHC Exchange |
$34.49
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHC Medicaid |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: UHCCP Medicaid |
$10.60
|
| Rate for Payer: UMR Bronson Commercial |
$4,644.17
|
| Rate for Payer: UMR Bronson Commercial |
$928.83
|
| Rate for Payer: VA VA |
$20.26
|
| Rate for Payer: VA VA |
$20.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,882.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,413.85
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,037.61
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$896.55 |
| Max. Negotiated Rate |
$1,833.85 |
| Rate for Payer: Aetna American Axle |
$1,324.45
|
| Rate for Payer: Aetna American Axle |
$6,259.75
|
| Rate for Payer: Aetna Commercial |
$1,731.97
|
| Rate for Payer: Aetna Commercial |
$8,185.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,324.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,259.75
|
| Rate for Payer: Cash Price |
$1,630.09
|
| Rate for Payer: Cash Price |
$7,704.30
|
| Rate for Payer: Cofinity Advantage |
$6,741.27
|
| Rate for Payer: Cofinity Advantage |
$1,426.33
|
| Rate for Payer: Cofinity Commercial |
$8,282.13
|
| Rate for Payer: Cofinity Commercial |
$1,752.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,704.30
|
| Rate for Payer: Healthscope Commercial |
$1,833.85
|
| Rate for Payer: Healthscope Commercial |
$8,667.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,741.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,426.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,528.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,222.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,731.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,185.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,528.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,222.78
|
| Rate for Payer: PHP Commercial |
$1,731.97
|
| Rate for Payer: PHP Commercial |
$8,185.82
|
| Rate for Payer: Priority Health SBD |
$6,067.14
|
| Rate for Payer: Priority Health SBD |
$1,283.69
|
| Rate for Payer: UMR Bronson Commercial |
$896.55
|
| Rate for Payer: UMR Bronson Commercial |
$4,237.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,528.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,222.78
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$9,630.38
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
192561
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$8,667.34 |
| Rate for Payer: Aetna American Axle |
$6,259.75
|
| Rate for Payer: Aetna American Axle |
$1,324.45
|
| Rate for Payer: Aetna Commercial |
$1,731.97
|
| Rate for Payer: Aetna Commercial |
$8,185.82
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna Medicare |
$14.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,324.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,259.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.11
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS Complete |
$7.52
|
| Rate for Payer: BCBS MAPPO |
$13.69
|
| Rate for Payer: BCBS MAPPO |
$13.69
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCN Commercial |
$54.74
|
| Rate for Payer: BCN Commercial |
$54.74
|
| Rate for Payer: BCN Medicare Advantage |
$13.69
|
| Rate for Payer: BCN Medicare Advantage |
$13.69
|
| Rate for Payer: Cash Price |
$1,630.09
|
| Rate for Payer: Cash Price |
$7,704.30
|
| Rate for Payer: Cash Price |
$7,704.30
|
| Rate for Payer: Cash Price |
$1,630.09
|
| Rate for Payer: Cofinity Advantage |
$6,741.27
|
| Rate for Payer: Cofinity Advantage |
$1,426.33
|
| Rate for Payer: Cofinity Commercial |
$1,752.34
|
| Rate for Payer: Cofinity Commercial |
$8,282.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,704.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.69
|
| Rate for Payer: Healthscope Commercial |
$1,833.85
|
| Rate for Payer: Healthscope Commercial |
$8,667.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,741.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,426.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,528.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7,222.78
|
| Rate for Payer: Mclaren Medicaid |
$13.69
|
| Rate for Payer: Mclaren Medicaid |
$13.69
|
| Rate for Payer: Mclaren Medicare |
$13.69
|
| Rate for Payer: Mclaren Medicare |
$13.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.37
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: Meridian Medicaid |
$14.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,731.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,185.82
|
| Rate for Payer: Nomi Health Commercial |
$41.07
|
| Rate for Payer: Nomi Health Commercial |
$41.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,222.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,528.21
|
| Rate for Payer: PACE Medicare |
$13.01
|
| Rate for Payer: PACE Medicare |
$13.01
|
| Rate for Payer: PACE SWMI |
$13.69
|
| Rate for Payer: PACE SWMI |
$13.69
|
| Rate for Payer: PHP Commercial |
$1,731.97
|
| Rate for Payer: PHP Commercial |
$8,185.82
|
| Rate for Payer: PHP Medicare Advantage |
$13.69
|
| Rate for Payer: PHP Medicare Advantage |
$13.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87.82
|
| Rate for Payer: Priority Health Medicare |
$13.69
|
| Rate for Payer: Priority Health Medicare |
$13.69
|
| Rate for Payer: Priority Health SBD |
$1,283.69
|
| Rate for Payer: Priority Health SBD |
$6,067.14
|
| Rate for Payer: Priority Health Tiered Network |
$70.26
|
| Rate for Payer: Priority Health Tiered Network |
$70.26
|
| Rate for Payer: Railroad Medicare Medicare |
$13.69
|
| Rate for Payer: Railroad Medicare Medicare |
$13.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.90
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Core |
$21.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.69
|
| Rate for Payer: UHC Exchange |
$21.90
|
| Rate for Payer: UHC Exchange |
$21.90
|
| Rate for Payer: UHC Medicaid |
$7.16
|
| Rate for Payer: UHC Medicaid |
$7.16
|
| Rate for Payer: UHCCP Medicaid |
$7.16
|
| Rate for Payer: UHCCP Medicaid |
$7.16
|
| Rate for Payer: UMR Bronson Commercial |
$753.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,563.24
|
| Rate for Payer: VA VA |
$13.69
|
| Rate for Payer: VA VA |
$13.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7,222.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,528.21
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna American Axle |
$4.58
|
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.58
|
| Rate for Payer: UHC Core |
$3.67
|
| Rate for Payer: UHC Exchange |
$2.77
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna American Axle |
$4.58
|
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna American Axle |
$4.58
|
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Advantage |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$11.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.28
|
| Rate for Payer: UHC Core |
$12.24
|
| Rate for Payer: UHC Exchange |
$9.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna American Axle |
$15.28
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Advantage |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
