Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$27.50

Service Code	NDC 00409955805
Hospital Charge Code	12734
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 INTRAVENOUS SOLUTION

Facility

$19.67

Service Code	NDC 67457022805
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$7.87
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 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	$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 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

$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

$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

$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

$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

$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

$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

$19.67

Service Code	NDC 67457022800
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$7.87
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 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

$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

$24.09

Service Code	NDC 39822420001
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$9.64
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 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

$25.31

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

$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

$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

$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 IV (CODE)

Facility

$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

$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

$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

$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

$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

$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

$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

$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

Know your out-of-pocket cost for care.

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