|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.50
|
| Rate for Payer: BCBS Complete |
$10.16
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health SBD |
$16.00
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.31
|
|
|
Service Code
|
NDC 47781061620
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.45
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health SBD |
$15.95
|
|
|
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 |
$9.46 |
| 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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
NDC 43547053001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health SBD |
$9.95
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.64
|
|
|
Service Code
|
NDC 00143925010
|
| 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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
NDC 71288070006
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.46 |
| 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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
NDC 43547053001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna Commercial |
$13.43
|
| Rate for Payer: Aetna Medicare |
$7.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.27
|
| Rate for Payer: BCBS Complete |
$6.32
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$11.06
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$14.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.43
|
| Rate for Payer: PHP Commercial |
$13.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.27
|
| Rate for Payer: Priority Health SBD |
$9.95
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.87
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$21.99
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.82
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.99
|
| Rate for Payer: PHP Commercial |
$21.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health SBD |
$16.30
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$27.50
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$24.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health SBD |
$17.32
|
|
|
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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| 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 |
$9.46 |
| 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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
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 |
$9.46 |
| 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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
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 Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.55
|
| 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: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health SBD |
$14.89
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$27.50
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Medicare |
$13.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.88
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$19.25
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$24.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health SBD |
$17.32
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.87
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$21.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.82
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$23.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.99
|
| Rate for Payer: PHP Commercial |
$21.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health SBD |
$16.30
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$116.21
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: Aetna Medicare |
$58.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.54
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: Cash Price |
$92.97
|
| Rate for Payer: Cofinity Commercial |
$81.35
|
| Rate for Payer: Cofinity Commercial |
$99.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.97
|
| Rate for Payer: Healthscope Commercial |
$104.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.78
|
| Rate for Payer: PHP Commercial |
$98.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.54
|
| Rate for Payer: Priority Health SBD |
$73.21
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$186.77
|
|
|
Service Code
|
NDC 43547000503
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.71 |
| Max. Negotiated Rate |
$168.09 |
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Medicare |
$93.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.40
|
| Rate for Payer: BCBS Complete |
$74.71
|
| Rate for Payer: Cash Price |
$149.42
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.42
|
| Rate for Payer: Healthscope Commercial |
$168.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.40
|
| Rate for Payer: Priority Health SBD |
$117.67
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$593.68 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna Medicare |
$742.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.72
|
| Rate for Payer: BCBS Complete |
$593.68
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,038.93
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health SBD |
$935.04
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$186.77
|
|
|
Service Code
|
NDC 43547000503
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.67 |
| Max. Negotiated Rate |
$168.09 |
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.40
|
| Rate for Payer: Cash Price |
$149.42
|
| Rate for Payer: Cofinity Commercial |
$130.74
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.42
|
| Rate for Payer: Healthscope Commercial |
$168.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.75
|
| Rate for Payer: PHP Commercial |
$158.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.40
|
| Rate for Payer: Priority Health SBD |
$117.67
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$935.04 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.72
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,038.93
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,038.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health SBD |
$935.04
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$116.21
|
|
|
Service Code
|
NDC 68382096906
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.21 |
| Max. Negotiated Rate |
$104.59 |
| Rate for Payer: Aetna Commercial |
$98.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.54
|
| Rate for Payer: Cash Price |
$92.97
|
| Rate for Payer: Cofinity Commercial |
$81.35
|
| Rate for Payer: Cofinity Commercial |
$99.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.97
|
| Rate for Payer: Healthscope Commercial |
$104.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.78
|
| Rate for Payer: PHP Commercial |
$98.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.54
|
| Rate for Payer: Priority Health SBD |
$73.21
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$3,964.01 |
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.76
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$11.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.01
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Commercial |
$3,083.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.01
|
| Rate for Payer: Healthscope Commercial |
$3,964.01
|
| Rate for Payer: Mclaren Medicaid |
$5.90
|
| Rate for Payer: Mclaren Medicare |
$11.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.56
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: PACE Medicare |
$10.46
|
| Rate for Payer: PACE SWMI |
$11.01
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: PHP Medicare Advantage |
$11.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health Medicare |
$11.01
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
| Rate for Payer: Railroad Medicare Medicare |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.01
|
| Rate for Payer: UHC Medicare Advantage |
$11.01
|
| Rate for Payer: UHCCP Medicaid |
$6.20
|
| Rate for Payer: VA VA |
$11.01
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,404.45
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,774.80 |
| Max. Negotiated Rate |
$3,964.01 |
| Rate for Payer: Aetna Commercial |
$3,743.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,862.89
|
| Rate for Payer: Cash Price |
$3,523.56
|
| Rate for Payer: Cofinity Commercial |
$3,083.11
|
| Rate for Payer: Cofinity Commercial |
$3,787.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,083.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,523.56
|
| Rate for Payer: Healthscope Commercial |
$3,964.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,743.78
|
| Rate for Payer: PHP Commercial |
$3,743.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,862.89
|
| Rate for Payer: Priority Health SBD |
$2,774.80
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$7,157.13
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$6,441.42 |
| Rate for Payer: Aetna Commercial |
$6,083.56
|
| Rate for Payer: Aetna Medicare |
$11.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,652.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.76
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$11.01
|
| Rate for Payer: BCN Medicare Advantage |
$11.01
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cofinity Commercial |
$6,155.13
|
| Rate for Payer: Cofinity Commercial |
$5,009.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,009.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,725.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.01
|
| Rate for Payer: Healthscope Commercial |
$6,441.42
|
| Rate for Payer: Mclaren Medicaid |
$5.90
|
| Rate for Payer: Mclaren Medicare |
$11.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.56
|
| Rate for Payer: Meridian Medicaid |
$6.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,083.56
|
| Rate for Payer: PACE Medicare |
$10.46
|
| Rate for Payer: PACE SWMI |
$11.01
|
| Rate for Payer: PHP Commercial |
$6,083.56
|
| Rate for Payer: PHP Medicare Advantage |
$11.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,652.13
|
| Rate for Payer: Priority Health Medicare |
$11.01
|
| Rate for Payer: Priority Health SBD |
$4,508.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.01
|
| Rate for Payer: UHC Medicare Advantage |
$11.01
|
| Rate for Payer: UHCCP Medicaid |
$6.20
|
| Rate for Payer: VA VA |
$11.01
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,157.13
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,508.99 |
| Max. Negotiated Rate |
$6,441.42 |
| Rate for Payer: Aetna Commercial |
$6,083.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,652.13
|
| Rate for Payer: Cash Price |
$5,725.70
|
| Rate for Payer: Cofinity Commercial |
$5,009.99
|
| Rate for Payer: Cofinity Commercial |
$6,155.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,009.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,725.70
|
| Rate for Payer: Healthscope Commercial |
$6,441.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,083.56
|
| Rate for Payer: PHP Commercial |
$6,083.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,652.13
|
| Rate for Payer: Priority Health SBD |
$4,508.99
|
|
