Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$39.03

Service Code	NDC 47781030411
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$15.61
Max. Negotiated Rate	$35.13
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: 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

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,170.83

Service Code	NDC 47781030403
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$737.62
Max. Negotiated Rate	$1,053.75
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: 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

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$78.69

Service Code	NDC 00078050261
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$49.57
Max. Negotiated Rate	$70.82
Rate for Payer: Aetna Commercial	$66.89
Rate for Payer: Aetna New Business (MI Preferred)	$51.15
Rate for Payer: Cash Price	$62.95
Rate for Payer: Cofinity Commercial	$55.08
Rate for Payer: Cofinity Commercial	$67.67
Rate for Payer: Cofinity Medicare Advantage	$55.08
Rate for Payer: Encore Health Key Benefits Commercial	$62.95
Rate for Payer: Healthscope Commercial	$70.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.89
Rate for Payer: PHP Commercial	$66.89
Rate for Payer: Priority Health Cigna Priority Health	$51.15
Rate for Payer: Priority Health SBD	$49.57

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$2,360.53

Service Code	NDC 00078050215
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$1,487.13
Max. Negotiated Rate	$2,124.48
Rate for Payer: Aetna Commercial	$2,006.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,534.34
Rate for Payer: Cash Price	$1,888.42
Rate for Payer: Cofinity Commercial	$1,652.37
Rate for Payer: Cofinity Commercial	$2,030.06
Rate for Payer: Cofinity Medicare Advantage	$1,652.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,888.42
Rate for Payer: Healthscope Commercial	$2,124.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,006.45
Rate for Payer: PHP Commercial	$2,006.45
Rate for Payer: Priority Health Cigna Priority Health	$1,534.34
Rate for Payer: Priority Health SBD	$1,487.13

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$46.52

Service Code	NDC 00781730958
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$41.87
Rate for Payer: Aetna Commercial	$39.54
Rate for Payer: Aetna New Business (MI Preferred)	$30.24
Rate for Payer: Cash Price	$37.22
Rate for Payer: Cofinity Commercial	$32.56
Rate for Payer: Cofinity Commercial	$40.01
Rate for Payer: Cofinity Medicare Advantage	$32.56
Rate for Payer: Encore Health Key Benefits Commercial	$37.22
Rate for Payer: Healthscope Commercial	$41.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.54
Rate for Payer: PHP Commercial	$39.54
Rate for Payer: Priority Health Cigna Priority Health	$30.24
Rate for Payer: Priority Health SBD	$29.31

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$46.52

Service Code	NDC 00781730958
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$18.61
Max. Negotiated Rate	$41.87
Rate for Payer: Aetna Commercial	$39.54
Rate for Payer: Aetna Medicare	$23.26
Rate for Payer: Aetna New Business (MI Preferred)	$30.24
Rate for Payer: BCBS Complete	$18.61
Rate for Payer: Cash Price	$37.22
Rate for Payer: Cofinity Commercial	$32.56
Rate for Payer: Cofinity Commercial	$40.01
Rate for Payer: Cofinity Medicare Advantage	$32.56
Rate for Payer: Encore Health Key Benefits Commercial	$37.22
Rate for Payer: Healthscope Commercial	$41.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.54
Rate for Payer: PHP Commercial	$39.54
Rate for Payer: Priority Health Cigna Priority Health	$30.24
Rate for Payer: Priority Health SBD	$29.31

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,395.39

Service Code	NDC 00781730931
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$879.10
Max. Negotiated Rate	$1,255.85
Rate for Payer: Aetna Commercial	$1,186.08
Rate for Payer: Aetna New Business (MI Preferred)	$907.00
Rate for Payer: Cash Price	$1,116.31
Rate for Payer: Cofinity Commercial	$1,200.04
Rate for Payer: Cofinity Commercial	$976.77
Rate for Payer: Cofinity Medicare Advantage	$976.77
Rate for Payer: Encore Health Key Benefits Commercial	$1,116.31
Rate for Payer: Healthscope Commercial	$1,255.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,186.08
Rate for Payer: PHP Commercial	$1,186.08
Rate for Payer: Priority Health Cigna Priority Health	$907.00
Rate for Payer: Priority Health SBD	$879.10

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$2,360.53

Service Code	NDC 00078050215
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$944.21
Max. Negotiated Rate	$2,124.48
Rate for Payer: Aetna Commercial	$2,006.45
Rate for Payer: Aetna Medicare	$1,180.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,534.34
Rate for Payer: BCBS Complete	$944.21
Rate for Payer: Cash Price	$1,888.42
Rate for Payer: Cofinity Commercial	$1,652.37
Rate for Payer: Cofinity Commercial	$2,030.06
Rate for Payer: Cofinity Medicare Advantage	$1,652.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,888.42
Rate for Payer: Healthscope Commercial	$2,124.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,006.45
Rate for Payer: PHP Commercial	$2,006.45
Rate for Payer: Priority Health Cigna Priority Health	$1,534.34
Rate for Payer: Priority Health SBD	$1,487.13

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$78.69

Service Code	NDC 00078050261
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$31.48
Max. Negotiated Rate	$70.82
Rate for Payer: Aetna Commercial	$66.89
Rate for Payer: Aetna Medicare	$39.34
Rate for Payer: Aetna New Business (MI Preferred)	$51.15
Rate for Payer: BCBS Complete	$31.48
Rate for Payer: Cash Price	$62.95
Rate for Payer: Cofinity Commercial	$55.08
Rate for Payer: Cofinity Commercial	$67.67
Rate for Payer: Cofinity Medicare Advantage	$55.08
Rate for Payer: Encore Health Key Benefits Commercial	$62.95
Rate for Payer: Healthscope Commercial	$70.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.89
Rate for Payer: PHP Commercial	$66.89
Rate for Payer: Priority Health Cigna Priority Health	$51.15
Rate for Payer: Priority Health SBD	$49.57

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,395.39

Service Code	NDC 00781730931
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$558.16
Max. Negotiated Rate	$1,255.85
Rate for Payer: Aetna Commercial	$1,186.08
Rate for Payer: Aetna Medicare	$697.70
Rate for Payer: Aetna New Business (MI Preferred)	$907.00
Rate for Payer: BCBS Complete	$558.16
Rate for Payer: Cash Price	$1,116.31
Rate for Payer: Cofinity Commercial	$1,200.04
Rate for Payer: Cofinity Commercial	$976.77
Rate for Payer: Cofinity Medicare Advantage	$976.77
Rate for Payer: Encore Health Key Benefits Commercial	$1,116.31
Rate for Payer: Healthscope Commercial	$1,255.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,186.08
Rate for Payer: PHP Commercial	$1,186.08
Rate for Payer: Priority Health Cigna Priority Health	$907.00
Rate for Payer: Priority Health SBD	$879.10

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$23.64

Service Code	NDC 00143925010
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

$24.00

Service Code	NDC 43066000710
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna New Business (MI Preferred)	$15.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$16.80
Rate for Payer: Cofinity Commercial	$20.64
Rate for Payer: Cofinity Medicare Advantage	$16.80
Rate for Payer: Encore Health Key Benefits Commercial	$19.20
Rate for Payer: Healthscope Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.40
Rate for Payer: PHP Commercial	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$15.60
Rate for Payer: Priority Health SBD	$15.12

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$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 Commercial	$13.77
Rate for Payer: Cofinity Commercial	$16.92
Rate for Payer: Cofinity Medicare Advantage	$13.77
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: PHP Commercial	$16.72
Rate for Payer: Priority Health Cigna Priority Health	$12.79
Rate for Payer: Priority Health SBD	$12.39

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$25.87

Service Code	NDC 00781322095
Hospital Charge Code	12734
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 INTRAVENOUS SOLUTION

Facility

$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

$15.80

Service Code	NDC 43547053010
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 INTRAVENOUS SOLUTION

Facility

$25.31

Service Code	NDC 47781061617
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$22.78
Rate for Payer: Aetna Commercial	$21.51
Rate for Payer: Aetna Medicare	$12.66
Rate for Payer: Aetna New Business (MI Preferred)	$16.45
Rate for Payer: BCBS Complete	$10.12
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

$19.67

Service Code	NDC 67457022800
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 Commercial	$13.77
Rate for Payer: Cofinity Commercial	$16.92
Rate for Payer: Cofinity Medicare Advantage	$13.77
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: PHP Commercial	$16.72
Rate for Payer: Priority Health Cigna Priority Health	$12.79
Rate for Payer: Priority Health SBD	$12.39

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$23.64

Service Code	NDC 71288070005
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

$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

$15.80

Service Code	NDC 43547053010
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

$24.00

Service Code	NDC 43066000710
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$9.60
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna Commercial	$20.40
Rate for Payer: Aetna Medicare	$12.00
Rate for Payer: Aetna New Business (MI Preferred)	$15.60
Rate for Payer: BCBS Complete	$9.60
Rate for Payer: Cash Price	$19.20
Rate for Payer: Cofinity Commercial	$16.80
Rate for Payer: Cofinity Commercial	$20.64
Rate for Payer: Cofinity Medicare Advantage	$16.80
Rate for Payer: Encore Health Key Benefits Commercial	$19.20
Rate for Payer: Healthscope Commercial	$21.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.40
Rate for Payer: PHP Commercial	$20.40
Rate for Payer: Priority Health Cigna Priority Health	$15.60
Rate for Payer: Priority Health SBD	$15.12

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$24.09

Service Code	NDC 39822420002
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 Commercial	$16.86
Rate for Payer: Cofinity Commercial	$20.72
Rate for Payer: Cofinity Medicare Advantage	$16.86
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: PHP Commercial	$20.48
Rate for Payer: Priority Health Cigna Priority Health	$15.66
Rate for Payer: Priority Health SBD	$15.18

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$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

$25.31

Service Code	NDC 47781061617
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

Know your out-of-pocket cost for care.

All Charges