|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
NDC 43547053010
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna Commercial |
$15.47
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.83
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cofinity Advantage |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$16.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.65
|
| Rate for Payer: PHP Commercial |
$15.47
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.83
|
| Rate for Payer: UHC Core |
$9.48
|
| Rate for Payer: UHC Exchange |
$7.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health SBD |
$15.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.66
|
| Rate for Payer: UHC Core |
$12.55
|
| Rate for Payer: UHC Exchange |
$9.47
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.64
|
|
|
Service Code
|
NDC 00143925001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.37
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Advantage |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
NDC 43547053001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna Commercial |
$15.47
|
| Rate for Payer: Aetna Medicare |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.83
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cofinity Advantage |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$16.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.65
|
| Rate for Payer: PHP Commercial |
$15.47
|
| Rate for Payer: Priority Health SBD |
$11.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.83
|
| Rate for Payer: UHC Core |
$9.48
|
| Rate for Payer: UHC Exchange |
$7.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 39822420001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.66
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health SBD |
$15.18
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Advantage |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.75
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health SBD |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.79
|
| Rate for Payer: UHC Core |
$10.25
|
| Rate for Payer: UHC Exchange |
$7.73
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Advantage |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.75
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health SBD |
$12.39
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.23
|
|
|
Service Code
|
NDC 71288070006
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Advantage |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.17
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: Priority Health SBD |
$12.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.15
|
| Rate for Payer: UHC Core |
$10.54
|
| Rate for Payer: UHC Exchange |
$7.95
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.23
|
|
|
Service Code
|
NDC 71288070006
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Advantage |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.17
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: Priority Health SBD |
$12.74
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
NDC 65145013001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$16.99
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 67457022800
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.73 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.79
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Advantage |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.75
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health SBD |
$12.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.79
|
| Rate for Payer: UHC Core |
$10.25
|
| Rate for Payer: UHC Exchange |
$7.73
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
NDC 65145013010
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.53
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: UHC Exchange |
$10.60
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
NDC 00143925001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.37
|
| Rate for Payer: BCBS Complete |
$9.46
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Advantage |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health SBD |
$14.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: UHC Exchange |
$9.29
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$19.12
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.51 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: Aetna Medicare |
$9.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.43
|
| Rate for Payer: BCBS Complete |
$7.65
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Advantage |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$17.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.34
|
| Rate for Payer: PHP Commercial |
$16.25
|
| Rate for Payer: Priority Health SBD |
$12.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.43
|
| Rate for Payer: UHC Core |
$9.96
|
| Rate for Payer: UHC Exchange |
$7.51
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$26.31
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.58 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.10
|
| Rate for Payer: Cash Price |
$21.05
|
| Rate for Payer: Cofinity Advantage |
$18.42
|
| Rate for Payer: Cofinity Commercial |
$22.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.05
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.73
|
| Rate for Payer: PHP Commercial |
$22.36
|
| Rate for Payer: Priority Health SBD |
$16.58
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$19.12
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.43
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Advantage |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$17.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.34
|
| Rate for Payer: PHP Commercial |
$16.25
|
| Rate for Payer: Priority Health SBD |
$12.05
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$23.64
|
|
|
Service Code
|
NDC 00143925001
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.37
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Advantage |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.37
|
| Rate for Payer: BCBS Complete |
$9.46
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Advantage |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health SBD |
$14.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: UHC Exchange |
$9.29
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
NDC 00143925001
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$11.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.37
|
| Rate for Payer: BCBS Complete |
$9.46
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Advantage |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health SBD |
$14.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$12.32
|
| Rate for Payer: UHC Exchange |
$9.29
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$26.31
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.10
|
| Rate for Payer: BCBS Complete |
$10.52
|
| Rate for Payer: Cash Price |
$21.05
|
| Rate for Payer: Cofinity Advantage |
$18.42
|
| Rate for Payer: Cofinity Commercial |
$22.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.05
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.73
|
| Rate for Payer: PHP Commercial |
$22.36
|
| Rate for Payer: Priority Health SBD |
$16.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.10
|
| Rate for Payer: UHC Core |
$13.71
|
| Rate for Payer: UHC Exchange |
$10.34
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$23.64
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.37
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Advantage |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$343.55
|
|
|
Service Code
|
NDC 60687078621
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$309.19 |
| Rate for Payer: Aetna Commercial |
$292.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.31
|
| Rate for Payer: Cash Price |
$274.84
|
| Rate for Payer: Cofinity Advantage |
$240.49
|
| Rate for Payer: Cofinity Commercial |
$295.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.84
|
| Rate for Payer: Healthscope Commercial |
$309.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.66
|
| Rate for Payer: PHP Commercial |
$292.02
|
| Rate for Payer: Priority Health SBD |
$216.44
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,528.81
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,375.93 |
| Rate for Payer: Aetna Commercial |
$1,299.49
|
| Rate for Payer: Aetna Medicare |
$764.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.73
|
| Rate for Payer: BCBS Complete |
$611.52
|
| Rate for Payer: Cash Price |
$1,223.05
|
| Rate for Payer: Cofinity Advantage |
$1,070.17
|
| Rate for Payer: Cofinity Commercial |
$1,314.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.05
|
| Rate for Payer: Healthscope Commercial |
$1,375.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,223.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.61
|
| Rate for Payer: PHP Commercial |
$1,299.49
|
| Rate for Payer: Priority Health SBD |
$963.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.73
|
| Rate for Payer: UHC Core |
$796.51
|
| Rate for Payer: UHC Exchange |
$600.82
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$225.94
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.79 |
| Max. Negotiated Rate |
$203.35 |
| Rate for Payer: Aetna Commercial |
$192.05
|
| Rate for Payer: Aetna Medicare |
$112.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.86
|
| Rate for Payer: BCBS Complete |
$90.38
|
| Rate for Payer: Cash Price |
$180.75
|
| Rate for Payer: Cofinity Advantage |
$158.16
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.75
|
| Rate for Payer: Healthscope Commercial |
$203.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.46
|
| Rate for Payer: PHP Commercial |
$192.05
|
| Rate for Payer: Priority Health SBD |
$142.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.86
|
| Rate for Payer: UHC Core |
$117.71
|
| Rate for Payer: UHC Exchange |
$88.79
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$140.79
|
|
|
Service Code
|
NDC 43547000503
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.70 |
| Max. Negotiated Rate |
$126.71 |
| Rate for Payer: Aetna Commercial |
$119.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.51
|
| Rate for Payer: Cash Price |
$112.63
|
| Rate for Payer: Cofinity Advantage |
$98.55
|
| Rate for Payer: Cofinity Commercial |
$121.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.63
|
| Rate for Payer: Healthscope Commercial |
$126.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.59
|
| Rate for Payer: PHP Commercial |
$119.67
|
| Rate for Payer: Priority Health SBD |
$88.70
|
|
