|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
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 Commercial |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.94
|
| 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 |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458057930
|
| Hospital Charge Code |
155831
|
|
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 Commercial |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.94
|
| 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 |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| 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 20 MG TABLET
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 50458057901
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 50458057901
|
| Hospital Charge Code |
155831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458057930
|
| Hospital Charge Code |
155831
|
|
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 Commercial |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.94
|
| 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 |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057910
|
| Hospital Charge Code |
155831
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 20 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057910
|
| Hospital Charge Code |
155831
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| 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
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$14.10
|
|
|
Service Code
|
NDC 50458057760
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna American Axle |
$9.16
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.16
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.16
|
| Rate for Payer: Priority Health SBD |
$8.88
|
| Rate for Payer: UMR Bronson Commercial |
$6.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.58
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$14.10
|
|
|
Service Code
|
NDC 50458057760
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$12.69 |
| Rate for Payer: Aetna American Axle |
$9.16
|
| Rate for Payer: Aetna Commercial |
$11.98
|
| Rate for Payer: Aetna Medicare |
$7.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.16
|
| Rate for Payer: BCBS Complete |
$5.64
|
| Rate for Payer: Cash Price |
$11.28
|
| Rate for Payer: Cofinity Commercial |
$12.13
|
| Rate for Payer: Cofinity Commercial |
$9.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.28
|
| Rate for Payer: Healthscope Commercial |
$12.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.98
|
| Rate for Payer: PHP Commercial |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.16
|
| Rate for Payer: Priority Health SBD |
$8.88
|
| Rate for Payer: UMR Bronson Commercial |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.58
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057710
|
| Hospital Charge Code |
188575
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$0.24
|
|
|
Service Code
|
NDC 50458057701
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057710
|
| Hospital Charge Code |
188575
|
|
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 Commercial |
$16.45
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: 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: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| 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
|
|
|
RIVAROXABAN 2.5 MG TABLET
|
Facility
|
OP
|
$0.24
|
|
|
Service Code
|
NDC 50458057701
|
| Hospital Charge Code |
188575
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Aetna American Axle |
$0.16
|
| Rate for Payer: Aetna Commercial |
$0.20
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$0.10
|
| Rate for Payer: Cash Price |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.19
|
| Rate for Payer: Healthscope Commercial |
$0.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.16
|
| Rate for Payer: Priority Health SBD |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.18
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,170.83
|
|
|
Service Code
|
NDC 47781040503
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$433.21 |
| Max. Negotiated Rate |
$1,053.75 |
| Rate for Payer: Aetna American Axle |
$761.04
|
| Rate for Payer: Aetna Commercial |
$995.21
|
| Rate for Payer: Aetna Medicare |
$585.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.04
|
| Rate for Payer: BCBS Complete |
$468.33
|
| Rate for Payer: Cash Price |
$936.66
|
| Rate for Payer: Cofinity Commercial |
$1,006.91
|
| Rate for Payer: Cofinity Commercial |
$819.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$819.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.66
|
| Rate for Payer: Healthscope Commercial |
$1,053.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$995.21
|
| Rate for Payer: PHP Commercial |
$995.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.04
|
| Rate for Payer: Priority Health SBD |
$737.62
|
| Rate for Payer: UMR Bronson Commercial |
$433.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.12
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$39.03
|
|
|
Service Code
|
NDC 47781040511
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna American Axle |
$25.37
|
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna Medicare |
$19.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.37
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$27.32
|
| Rate for Payer: Cofinity Commercial |
$33.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.18
|
| Rate for Payer: PHP Commercial |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.37
|
| Rate for Payer: Priority Health SBD |
$24.59
|
| Rate for Payer: UMR Bronson Commercial |
$14.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.27
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,170.83
|
|
|
Service Code
|
NDC 47781040503
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$515.17 |
| Max. Negotiated Rate |
$1,053.75 |
| Rate for Payer: Aetna American Axle |
$761.04
|
| Rate for Payer: Aetna Commercial |
$995.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.04
|
| Rate for Payer: Cash Price |
$936.66
|
| Rate for Payer: Cofinity Commercial |
$1,006.91
|
| Rate for Payer: Cofinity Commercial |
$819.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$819.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.66
|
| Rate for Payer: Healthscope Commercial |
$1,053.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$995.21
|
| Rate for Payer: PHP Commercial |
$995.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.04
|
| Rate for Payer: Priority Health SBD |
$737.62
|
| Rate for Payer: UMR Bronson Commercial |
$515.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.12
|
|
|
RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$39.03
|
|
|
Service Code
|
NDC 47781040511
|
| Hospital Charge Code |
162142
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna American Axle |
$25.37
|
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.37
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$27.32
|
| Rate for Payer: Cofinity Commercial |
$33.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.18
|
| Rate for Payer: PHP Commercial |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.37
|
| Rate for Payer: Priority Health SBD |
$24.59
|
| Rate for Payer: UMR Bronson Commercial |
$17.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.27
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UMR Bronson Commercial |
$57.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.32
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.32
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$159.56
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.21 |
| Max. Negotiated Rate |
$143.60 |
| Rate for Payer: Cash Price |
$127.65
|
| Rate for Payer: Cofinity Commercial |
$111.69
|
| Rate for Payer: Cofinity Commercial |
$137.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.69
|
| Rate for Payer: Aetna American Axle |
$103.71
|
| Rate for Payer: Aetna Commercial |
$135.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.65
|
| Rate for Payer: Healthscope Commercial |
$143.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.63
|
| Rate for Payer: PHP Commercial |
$135.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.71
|
| Rate for Payer: Priority Health SBD |
$100.52
|
| Rate for Payer: UMR Bronson Commercial |
$70.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.67
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$159.56
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$143.60 |
| Rate for Payer: Aetna American Axle |
$103.71
|
| Rate for Payer: Aetna Commercial |
$135.63
|
| Rate for Payer: Aetna Medicare |
$79.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.71
|
| Rate for Payer: BCBS Complete |
$63.82
|
| Rate for Payer: Cash Price |
$127.65
|
| Rate for Payer: Cofinity Commercial |
$111.69
|
| Rate for Payer: Cofinity Commercial |
$137.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.65
|
| Rate for Payer: Healthscope Commercial |
$143.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.63
|
| Rate for Payer: PHP Commercial |
$135.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.71
|
| Rate for Payer: Priority Health SBD |
$100.52
|
| Rate for Payer: UMR Bronson Commercial |
$59.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.67
|
|
|
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 Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.47
|
| 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: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| 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
|
$159.56
|
|
|
Service Code
|
NDC 55111035360
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$143.60 |
| Rate for Payer: Aetna American Axle |
$103.71
|
| Rate for Payer: Aetna Commercial |
$135.63
|
| Rate for Payer: Aetna Medicare |
$79.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.71
|
| Rate for Payer: BCBS Complete |
$63.82
|
| Rate for Payer: Cash Price |
$127.65
|
| Rate for Payer: Cofinity Commercial |
$111.69
|
| Rate for Payer: Cofinity Commercial |
$137.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.65
|
| Rate for Payer: Healthscope Commercial |
$143.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$111.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.63
|
| Rate for Payer: PHP Commercial |
$135.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.71
|
| Rate for Payer: Priority Health SBD |
$100.52
|
| Rate for Payer: UMR Bronson Commercial |
$59.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.67
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$175.56
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna American Axle |
$114.11
|
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.11
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Commercial |
$122.89
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.11
|
| Rate for Payer: Priority Health SBD |
$110.60
|
| Rate for Payer: UMR Bronson Commercial |
$64.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.67
|
|
