Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

rivastigmine 4.6 mg/24 hr TD film, ER [HMC]

Facility

OP

$38.79

Service Code	NDC 00781730431
Hospital Charge Code	3802984
Hospital Revenue Code	250
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: Humana Medicare Advantage	$16.29
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: UnitedHealthcare Medicaid	$15.52
Rate for Payer: WPPA Medicare Advantage	$23.27

rivastigmine 4.6 mg/24 hr TD film, ER [HMC]

Facility

IP

$38.79

Service Code	NDC 65162082534
Hospital Charge Code	3802984
Hospital Revenue Code	250
Min. Negotiated Rate	$34.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rivastigmine 4.6 mg/24 hr TD film, ER [HMC]

Facility

OP

$38.79

Service Code	NDC 65162082534
Hospital Charge Code	3802984
Hospital Revenue Code	250
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: Humana Medicare Advantage	$16.29
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: UnitedHealthcare Medicaid	$15.52
Rate for Payer: WPPA Medicare Advantage	$23.27

rivastigmine 4.6 mg/24 hr TD film, ER [HMC]

Facility

IP

$38.79

Service Code	NDC 00781730431
Hospital Charge Code	3802984
Hospital Revenue Code	250
Min. Negotiated Rate	$34.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rivastigmine 4.6 mg/24 hr TD film, ER [HMC]

Facility

IP

$32.44

Service Code	NDC 00078050115
Hospital Charge Code	3802984
Hospital Revenue Code	250
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: UnitedHealthcare Commercial	$30.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rivastigmine 4.6 mg/24 hr TD film, ER [HMC]

Facility

OP

$32.44

Service Code	NDC 00078050115
Hospital Charge Code	3802984
Hospital Revenue Code	250
Min. Negotiated Rate	$12.98
Max. Negotiated Rate	$30.82
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: Humana Medicare Advantage	$13.62
Rate for Payer: UnitedHealthcare Commercial	$30.82
Rate for Payer: UnitedHealthcare Medicaid	$12.98
Rate for Payer: WPPA Medicare Advantage	$19.46

rivastigmine 9.5 mg/24 hr Fil

Facility

IP

$38.79

Service Code	NDC 65162082634
Hospital Charge Code	3802990
Hospital Revenue Code	250
Min. Negotiated Rate	$34.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rivastigmine 9.5 mg/24 hr Fil

Facility

OP

$38.79

Service Code	NDC 65162082634
Hospital Charge Code	3802990
Hospital Revenue Code	250
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: Humana Medicare Advantage	$16.29
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: UnitedHealthcare Medicaid	$15.52
Rate for Payer: WPPA Medicare Advantage	$23.27

rivastigmine 9.5 mg/24 hr TD film, ER [HMC]

Facility

IP

$38.79

Service Code	NDC 00781730931
Hospital Charge Code	3802990
Hospital Revenue Code	250
Min. Negotiated Rate	$34.91
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rivastigmine 9.5 mg/24 hr TD film, ER [HMC]

Facility

OP

$38.79

Service Code	NDC 00781730931
Hospital Charge Code	3802990
Hospital Revenue Code	250
Min. Negotiated Rate	$15.52
Max. Negotiated Rate	$36.85
Rate for Payer: Aetna Commercial	$34.91
Rate for Payer: Humana Medicare Advantage	$16.29
Rate for Payer: UnitedHealthcare Commercial	$36.85
Rate for Payer: UnitedHealthcare Medicaid	$15.52
Rate for Payer: WPPA Medicare Advantage	$23.27

rivastigmine 9.5 mg/24 hr TD film, ER [HMC]

Facility

OP

$32.44

Service Code	NDC 00078050215
Hospital Charge Code	3802990
Hospital Revenue Code	250
Min. Negotiated Rate	$12.98
Max. Negotiated Rate	$30.82
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: Humana Medicare Advantage	$13.62
Rate for Payer: UnitedHealthcare Commercial	$30.82
Rate for Payer: UnitedHealthcare Medicaid	$12.98
Rate for Payer: WPPA Medicare Advantage	$19.46

rivastigmine 9.5 mg/24 hr TD film, ER [HMC]

Facility

IP

$32.44

Service Code	NDC 00078050215
Hospital Charge Code	3802990
Hospital Revenue Code	250
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$29.20
Rate for Payer: UnitedHealthcare Commercial	$30.82
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rizatriptan 10 mg Dis Tab [HMC]

Facility

IP

$34.56

Service Code	NDC 00378370259
Hospital Charge Code	3809747
Hospital Revenue Code	250
Min. Negotiated Rate	$31.10
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$31.10
Rate for Payer: UnitedHealthcare Commercial	$32.83
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rizatriptan 10 mg Dis Tab [HMC]

Facility

OP

$34.56

Service Code	NDC 00378370259
Hospital Charge Code	3809747
Hospital Revenue Code	250
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$32.83
Rate for Payer: Aetna Commercial	$31.10
Rate for Payer: Humana Medicare Advantage	$14.52
Rate for Payer: UnitedHealthcare Commercial	$32.83
Rate for Payer: UnitedHealthcare Medicaid	$13.82
Rate for Payer: WPPA Medicare Advantage	$20.74

rizatriptan 10 mg Tab [HMC]

Facility

OP

$51.88

Service Code	NDC 65862060012
Hospital Charge Code	3809747
Hospital Revenue Code	250
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$49.29
Rate for Payer: Aetna Commercial	$46.69
Rate for Payer: Humana Medicare Advantage	$21.79
Rate for Payer: UnitedHealthcare Commercial	$49.29
Rate for Payer: UnitedHealthcare Medicaid	$20.75
Rate for Payer: WPPA Medicare Advantage	$31.13

rizatriptan 10 mg Tab [HMC]

Facility

OP

$38.25

Service Code	NDC 00093747243
Hospital Charge Code	3809747
Hospital Revenue Code	250
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$36.34
Rate for Payer: Aetna Commercial	$34.42
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: UnitedHealthcare Commercial	$36.34
Rate for Payer: UnitedHealthcare Medicaid	$15.30
Rate for Payer: WPPA Medicare Advantage	$22.95

rizatriptan 10 mg Tab [HMC]

Facility

IP

$51.88

Service Code	NDC 65862060012
Hospital Charge Code	3809747
Hospital Revenue Code	250
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$46.69
Rate for Payer: UnitedHealthcare Commercial	$49.29
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rizatriptan 10 mg Tab [HMC]

Facility

IP

$38.25

Service Code	NDC 00093747243
Hospital Charge Code	3809747
Hospital Revenue Code	250
Min. Negotiated Rate	$34.42
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$34.42
Rate for Payer: UnitedHealthcare Commercial	$36.34
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RMSF IgG,IgM w/Refl To Titers QST

Facility

OP

$207.00

Service Code	HCPCS 86757
Hospital Charge Code	3552771
Hospital Revenue Code	300
Min. Negotiated Rate	$19.35
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$186.30
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$126.53
Rate for Payer: Humana Medicare Advantage	$86.94
Rate for Payer: UnitedHealthcare Commercial	$196.65
Rate for Payer: UnitedHealthcare Medicaid	$19.35
Rate for Payer: WPPA Medicare Advantage	$124.20

RMSF IgG,IgM w/Refl To Titers QST

Facility

IP

$207.00

Service Code	HCPCS 86757
Hospital Charge Code	3552771
Hospital Revenue Code	300
Min. Negotiated Rate	$186.30
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$186.30
Rate for Payer: UnitedHealthcare Commercial	$196.65
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RNP Ab QST

Facility

IP

$51.00

Service Code	HCPCS 86235
Hospital Charge Code	3556403
Hospital Revenue Code	300
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: WPPA Medicare Advantage	$1,200.00

RNP Ab QST

Facility

OP

$51.00

Service Code	HCPCS 86235
Hospital Charge Code	3556403
Hospital Revenue Code	300
Min. Negotiated Rate	$17.93
Max. Negotiated Rate	$52.26
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$52.26
Rate for Payer: Humana Medicare Advantage	$21.42
Rate for Payer: UnitedHealthcare Commercial	$48.45
Rate for Payer: UnitedHealthcare Medicaid	$17.93
Rate for Payer: WPPA Medicare Advantage	$30.60

rocuronium 10 mg/mL IV Sol 5 mL [HMC]

Facility

OP

$81.88

Service Code	NDC 61553032170
Hospital Charge Code	3170179
Hospital Revenue Code	250
Min. Negotiated Rate	$32.75
Max. Negotiated Rate	$77.79
Rate for Payer: Aetna Commercial	$73.69
Rate for Payer: Humana Medicare Advantage	$34.39
Rate for Payer: UnitedHealthcare Commercial	$77.79
Rate for Payer: UnitedHealthcare Medicaid	$32.75
Rate for Payer: WPPA Medicare Advantage	$49.13

rocuronium 10 mg/mL IV Sol 5 mL [HMC]

Facility

IP

$41.15

Service Code	NDC 72611075610
Hospital Charge Code	3170179
Hospital Revenue Code	250
Min. Negotiated Rate	$37.03
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$37.03
Rate for Payer: UnitedHealthcare Commercial	$39.09
Rate for Payer: WPPA Medicare Advantage	$1,200.00

rocuronium 10 mg/mL IV Sol 5 mL [HMC]

Facility

IP

$81.88

Service Code	NDC 61553032170
Hospital Charge Code	3170179
Hospital Revenue Code	250
Min. Negotiated Rate	$73.69
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$73.69
Rate for Payer: UnitedHealthcare Commercial	$77.79
Rate for Payer: WPPA Medicare Advantage	$1,200.00

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