|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$124.83
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.93 |
| Max. Negotiated Rate |
$112.35 |
| Rate for Payer: Aetna American Axle |
$81.14
|
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.14
|
| Rate for Payer: Cash Price |
$99.86
|
| Rate for Payer: Cofinity Advantage |
$87.38
|
| Rate for Payer: Cofinity Commercial |
$107.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.86
|
| Rate for Payer: Healthscope Commercial |
$112.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.62
|
| Rate for Payer: PHP Commercial |
$106.11
|
| Rate for Payer: Priority Health SBD |
$78.64
|
| Rate for Payer: UMR Bronson Commercial |
$54.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.62
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.65
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Exchange |
$61.46
|
| Rate for Payer: UMR Bronson Commercial |
$57.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$158.46
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$142.61 |
| Rate for Payer: Aetna American Axle |
$103.00
|
| Rate for Payer: Aetna Commercial |
$134.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.00
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cofinity Advantage |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.77
|
| Rate for Payer: Healthscope Commercial |
$142.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.84
|
| Rate for Payer: PHP Commercial |
$134.69
|
| Rate for Payer: Priority Health SBD |
$99.83
|
| Rate for Payer: UMR Bronson Commercial |
$69.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.84
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$156.39
|
|
|
Service Code
|
NDC 55111035360
|
| 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 Advantage |
$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 Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| 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
|
$156.39
|
|
|
Service Code
|
NDC 62756014686
|
| 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 Advantage |
$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 Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| 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
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 55111035360
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.65
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Exchange |
$61.46
|
| Rate for Payer: UMR Bronson Commercial |
$57.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$158.46
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$142.61 |
| Rate for Payer: Aetna American Axle |
$103.00
|
| Rate for Payer: Aetna Commercial |
$134.69
|
| Rate for Payer: Aetna Medicare |
$79.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.00
|
| Rate for Payer: BCBS Complete |
$63.38
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cofinity Advantage |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.77
|
| Rate for Payer: Healthscope Commercial |
$142.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.84
|
| Rate for Payer: PHP Commercial |
$134.69
|
| Rate for Payer: Priority Health SBD |
$99.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.00
|
| Rate for Payer: UHC Core |
$82.56
|
| Rate for Payer: UHC Exchange |
$62.27
|
| Rate for Payer: UMR Bronson Commercial |
$58.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.84
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 62756014686
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$78.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.65
|
| Rate for Payer: UHC Core |
$81.48
|
| Rate for Payer: UHC Exchange |
$61.46
|
| Rate for Payer: UMR Bronson Commercial |
$57.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$78.61
|
|
|
Service Code
|
NDC 00078050161
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.09 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna American Axle |
$51.10
|
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna Medicare |
$39.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: BCBS Complete |
$31.44
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.10
|
| Rate for Payer: UHC Core |
$40.96
|
| Rate for Payer: UHC Exchange |
$30.89
|
| Rate for Payer: UMR Bronson Commercial |
$29.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.96
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.61
|
|
|
Service Code
|
NDC 00078050161
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna American Axle |
$51.10
|
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: UMR Bronson Commercial |
$34.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.96
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$2,358.20
|
|
|
Service Code
|
NDC 00078050115
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$872.53 |
| Max. Negotiated Rate |
$2,122.38 |
| Rate for Payer: Aetna American Axle |
$1,532.83
|
| Rate for Payer: Aetna Commercial |
$2,004.47
|
| Rate for Payer: Aetna Medicare |
$1,179.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.83
|
| Rate for Payer: BCBS Complete |
$943.28
|
| Rate for Payer: Cash Price |
$1,886.56
|
| Rate for Payer: Cofinity Advantage |
$1,650.74
|
| Rate for Payer: Cofinity Commercial |
$2,028.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,886.56
|
| Rate for Payer: Healthscope Commercial |
$2,122.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,650.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,768.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,886.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,004.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.65
|
| Rate for Payer: PHP Commercial |
$2,004.47
|
| Rate for Payer: Priority Health SBD |
$1,485.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,532.83
|
| Rate for Payer: UHC Core |
$1,228.62
|
| Rate for Payer: UHC Exchange |
$926.77
|
| Rate for Payer: UMR Bronson Commercial |
$872.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,768.65
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,358.20
|
|
|
Service Code
|
NDC 00078050115
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,037.61 |
| Max. Negotiated Rate |
$2,122.38 |
| Rate for Payer: Aetna American Axle |
$1,532.83
|
| Rate for Payer: Aetna Commercial |
$2,004.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.83
|
| Rate for Payer: Cash Price |
$1,886.56
|
| Rate for Payer: Cofinity Advantage |
$1,650.74
|
| Rate for Payer: Cofinity Commercial |
$2,028.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,886.56
|
| Rate for Payer: Healthscope Commercial |
$2,122.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,650.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,768.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,004.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.65
|
| Rate for Payer: PHP Commercial |
$2,004.47
|
| Rate for Payer: Priority Health SBD |
$1,485.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,768.65
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.61
|
|
|
Service Code
|
NDC 00078050261
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.59 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna American Axle |
$51.10
|
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: UMR Bronson Commercial |
$34.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.96
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$78.61
|
|
|
Service Code
|
NDC 00078050261
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.09 |
| Max. Negotiated Rate |
$70.75 |
| Rate for Payer: Aetna American Axle |
$51.10
|
| Rate for Payer: Aetna Commercial |
$66.82
|
| Rate for Payer: Aetna Medicare |
$39.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.10
|
| Rate for Payer: BCBS Complete |
$31.44
|
| Rate for Payer: Cash Price |
$62.89
|
| Rate for Payer: Cofinity Advantage |
$55.03
|
| Rate for Payer: Cofinity Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.89
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.96
|
| Rate for Payer: PHP Commercial |
$66.82
|
| Rate for Payer: Priority Health SBD |
$49.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.10
|
| Rate for Payer: UHC Core |
$40.96
|
| Rate for Payer: UHC Exchange |
$30.89
|
| Rate for Payer: UMR Bronson Commercial |
$29.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.96
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 65162082634
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Advantage |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.64
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$118.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 65162082634
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$241.97 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$134.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Advantage |
$188.19
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$215.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.64
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.75
|
| Rate for Payer: UHC Core |
$140.07
|
| Rate for Payer: UHC Exchange |
$105.66
|
| Rate for Payer: UMR Bronson Commercial |
$99.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,358.20
|
|
|
Service Code
|
NDC 00078050215
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,037.61 |
| Max. Negotiated Rate |
$2,122.38 |
| Rate for Payer: Aetna American Axle |
$1,532.83
|
| Rate for Payer: Aetna Commercial |
$2,004.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.83
|
| Rate for Payer: Cash Price |
$1,886.56
|
| Rate for Payer: Cofinity Advantage |
$1,650.74
|
| Rate for Payer: Cofinity Commercial |
$2,028.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,886.56
|
| Rate for Payer: Healthscope Commercial |
$2,122.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,650.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,768.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,004.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.65
|
| Rate for Payer: PHP Commercial |
$2,004.47
|
| Rate for Payer: Priority Health SBD |
$1,485.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,768.65
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$2,358.20
|
|
|
Service Code
|
NDC 00078050215
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$872.53 |
| Max. Negotiated Rate |
$2,122.38 |
| Rate for Payer: Aetna American Axle |
$1,532.83
|
| Rate for Payer: Aetna Commercial |
$2,004.47
|
| Rate for Payer: Aetna Medicare |
$1,179.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.83
|
| Rate for Payer: BCBS Complete |
$943.28
|
| Rate for Payer: Cash Price |
$1,886.56
|
| Rate for Payer: Cofinity Advantage |
$1,650.74
|
| Rate for Payer: Cofinity Commercial |
$2,028.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,886.56
|
| Rate for Payer: Healthscope Commercial |
$2,122.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,650.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,768.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,886.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,004.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.65
|
| Rate for Payer: PHP Commercial |
$2,004.47
|
| Rate for Payer: Priority Health SBD |
$1,485.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,532.83
|
| Rate for Payer: UHC Core |
$1,228.62
|
| Rate for Payer: UHC Exchange |
$926.77
|
| Rate for Payer: UMR Bronson Commercial |
$872.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,768.65
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
OP
|
$6.73
|
|
|
Service Code
|
NDC 23155024522
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna American Axle |
$4.37
|
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: BCBS Complete |
$2.69
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Advantage |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health SBD |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.37
|
| Rate for Payer: UHC Core |
$3.51
|
| Rate for Payer: UHC Exchange |
$2.64
|
| Rate for Payer: UMR Bronson Commercial |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.05
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
IP
|
$6.73
|
|
|
Service Code
|
NDC 23155024522
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna American Axle |
$4.37
|
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Advantage |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health SBD |
$4.24
|
| Rate for Payer: UMR Bronson Commercial |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.05
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
OP
|
$121.05
|
|
|
Service Code
|
NDC 23155024546
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$102.89
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: Cash Price |
$96.84
|
| Rate for Payer: Cofinity Advantage |
$84.73
|
| Rate for Payer: Cofinity Commercial |
$104.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.84
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.79
|
| Rate for Payer: PHP Commercial |
$102.89
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.68
|
| Rate for Payer: UHC Core |
$63.07
|
| Rate for Payer: UHC Exchange |
$47.57
|
| Rate for Payer: UMR Bronson Commercial |
$44.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.79
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
IP
|
$121.05
|
|
|
Service Code
|
NDC 23155024546
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$102.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: Cash Price |
$96.84
|
| Rate for Payer: Cofinity Advantage |
$84.73
|
| Rate for Payer: Cofinity Commercial |
$104.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.84
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.79
|
| Rate for Payer: PHP Commercial |
$102.89
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.79
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.66
|
|
|
Service Code
|
NDC 00781322092
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna American Axle |
$16.03
|
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.03
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Advantage |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.50
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: Priority Health SBD |
$15.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
NDC 71839014101
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Advantage |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
NDC 63323042610
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna American Axle |
$25.57
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: UMR Bronson Commercial |
$17.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
