|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-9558-05
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$26.18
|
|
|
Service Code
|
NDC 55150-225-05
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$23.56 |
| Rate for Payer: Aetna Commercial |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$20.23
|
| Rate for Payer: BCN Commercial |
$20.23
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$23.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.25
|
| Rate for Payer: PHP Commercial |
$22.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.04
|
| Rate for Payer: UHC Core |
$21.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.64
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$20.63
|
|
|
Service Code
|
NDC 0143-9250-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$15.94
|
| Rate for Payer: BCN Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.50
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.54
|
| Rate for Payer: PHP Commercial |
$17.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.15
|
| Rate for Payer: UHC Core |
$17.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.47
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-9558-49
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$17.21
|
|
|
Service Code
|
NDC 25021-662-05
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$28.94
|
|
|
Service Code
|
NDC 72611-756-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$26.05 |
| Rate for Payer: UHC Core |
$24.16
|
| Rate for Payer: Aetna Commercial |
$24.60
|
| Rate for Payer: BCBS Trust/PPO |
$22.36
|
| Rate for Payer: BCN Commercial |
$22.36
|
| Rate for Payer: Cash Price |
$23.15
|
| Rate for Payer: Cofinity Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.15
|
| Rate for Payer: Healthscope Commercial |
$26.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.60
|
| Rate for Payer: PHP Commercial |
$24.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$17.21
|
|
|
Service Code
|
NDC 43066-007-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$17.21
|
|
|
Service Code
|
NDC 25021-662-05
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCN Commercial |
$13.30
|
| Rate for Payer: Cash Price |
$13.77
|
| Rate for Payer: Cofinity Commercial |
$14.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.63
|
| Rate for Payer: PHP Commercial |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.14
|
| Rate for Payer: UHC Core |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.91
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-9558-49
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$19.67
|
|
|
Service Code
|
NDC 67457-228-05
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$15.74
|
| 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: Lakeland Regional Health Systems Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.72
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.31
|
| Rate for Payer: UHC Core |
$16.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.75
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-9558-05
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$15.99
|
|
|
Service Code
|
NDC 0781-3220-95
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$14.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.59
|
| Rate for Payer: PHP Commercial |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC Core |
$13.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.99
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$20.65
|
|
|
Service Code
|
NDC 39822-4200-2
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.59 |
| Max. Negotiated Rate |
$18.58 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$15.96
|
| Rate for Payer: BCN Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.17
|
| Rate for Payer: UHC Core |
$17.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
IP
|
$18.21
|
|
|
Service Code
|
NDC 0703-2394-03
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.11 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.07
|
| Rate for Payer: BCN Commercial |
$14.07
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.48
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
IP
|
$1,374.52
|
|
|
Service Code
|
NDC 0310-0095-30
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$838.32 |
| Max. Negotiated Rate |
$1,237.07 |
| Rate for Payer: Aetna Commercial |
$1,168.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.23
|
| Rate for Payer: BCN Commercial |
$1,062.23
|
| Rate for Payer: Cash Price |
$1,099.62
|
| Rate for Payer: Cofinity Commercial |
$1,182.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,099.62
|
| Rate for Payer: Healthscope Commercial |
$1,237.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,030.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,168.34
|
| Rate for Payer: PHP Commercial |
$1,168.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,195.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$838.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,209.58
|
| Rate for Payer: UHC Core |
$1,147.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,030.89
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
IP
|
$3,894.98
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,375.55 |
| Max. Negotiated Rate |
$3,505.48 |
| Rate for Payer: Aetna Commercial |
$3,310.73
|
| Rate for Payer: BCBS Trust/PPO |
$3,010.04
|
| Rate for Payer: BCN Commercial |
$3,010.04
|
| Rate for Payer: Cash Price |
$3,115.98
|
| Rate for Payer: Cofinity Commercial |
$3,349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,115.98
|
| Rate for Payer: Healthscope Commercial |
$3,505.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,921.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,310.73
|
| Rate for Payer: PHP Commercial |
$3,310.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,726.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,388.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,375.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,427.58
|
| Rate for Payer: UHC Core |
$3,252.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,921.24
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
IP
|
$323.00
|
|
|
Service Code
|
NDC 0904-6373-61
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.00 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: BCBS Trust/PPO |
$249.61
|
| Rate for Payer: BCN Commercial |
$249.61
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.24
|
| Rate for Payer: UHC Core |
$269.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
IP
|
$103.40
|
|
|
Service Code
|
NDC 43547-268-10
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: BCBS Trust/PPO |
$79.91
|
| Rate for Payer: BCN Commercial |
$79.91
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
ROPINIROLE 0.5 MG TABLET
|
Facility
IP
|
$124.55
|
|
|
Service Code
|
NDC 43547-269-10
|
| Hospital Charge Code |
21800
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.96 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: BCBS Trust/PPO |
$96.25
|
| Rate for Payer: BCN Commercial |
$96.25
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.87
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.60
|
| Rate for Payer: UHC Core |
$104.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
IP
|
$352.45
|
|
|
Service Code
|
NDC 0904-6374-61
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.96 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$299.58
|
| Rate for Payer: BCBS Trust/PPO |
$272.37
|
| Rate for Payer: BCN Commercial |
$272.37
|
| Rate for Payer: Cash Price |
$281.96
|
| Rate for Payer: Cofinity Commercial |
$303.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$281.96
|
| Rate for Payer: Healthscope Commercial |
$317.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.58
|
| Rate for Payer: PHP Commercial |
$299.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.16
|
| Rate for Payer: UHC Core |
$294.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.34
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
NDC 43547-270-10
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$145.29
|
| Rate for Payer: BCN Commercial |
$145.29
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ROPINIROLE ER 2 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
IP
|
$222.45
|
|
|
Service Code
|
NDC 0228-3658-03
|
| Hospital Charge Code |
92015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.67 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$189.08
|
| Rate for Payer: BCBS Trust/PPO |
$171.91
|
| Rate for Payer: BCN Commercial |
$171.91
|
| Rate for Payer: Cash Price |
$177.96
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.96
|
| Rate for Payer: Healthscope Commercial |
$200.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.08
|
| Rate for Payer: PHP Commercial |
$189.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.76
|
| Rate for Payer: UHC Core |
$185.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.84
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
IP
|
$51.36
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$46.22 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Commercial |
$82.43
|
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Commercial |
$47.18
|
| Rate for Payer: BCBS Trust/PPO |
$74.95
|
| Rate for Payer: BCBS Trust/PPO |
$67.55
|
| Rate for Payer: BCBS Trust/PPO |
$39.69
|
| Rate for Payer: BCBS Trust/PPO |
$42.90
|
| Rate for Payer: BCN Commercial |
$39.69
|
| Rate for Payer: BCN Commercial |
$74.95
|
| Rate for Payer: BCN Commercial |
$42.90
|
| Rate for Payer: BCN Commercial |
$67.55
|
| Rate for Payer: Cash Price |
$69.93
|
| Rate for Payer: Cash Price |
$41.09
|
| Rate for Payer: Cash Price |
$77.58
|
| Rate for Payer: Cash Price |
$44.41
|
| Rate for Payer: Cofinity Commercial |
$47.74
|
| Rate for Payer: Cofinity Commercial |
$83.40
|
| Rate for Payer: Cofinity Commercial |
$75.17
|
| Rate for Payer: Cofinity Commercial |
$44.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.93
|
| Rate for Payer: Healthscope Commercial |
$78.67
|
| Rate for Payer: Healthscope Commercial |
$87.28
|
| Rate for Payer: Healthscope Commercial |
$49.96
|
| Rate for Payer: Healthscope Commercial |
$46.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.66
|
| Rate for Payer: PHP Commercial |
$47.18
|
| Rate for Payer: PHP Commercial |
$82.43
|
| Rate for Payer: PHP Commercial |
$43.66
|
| Rate for Payer: PHP Commercial |
$74.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.85
|
| Rate for Payer: UHC Core |
$46.35
|
| Rate for Payer: UHC Core |
$72.99
|
| Rate for Payer: UHC Core |
$42.89
|
| Rate for Payer: UHC Core |
$80.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.52
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
IP
|
$15.99
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Aetna Commercial |
$13.59
|
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$24.91
|
| Rate for Payer: BCBS Trust/PPO |
$22.65
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCBS Trust/PPO |
$16.20
|
| Rate for Payer: BCBS Trust/PPO |
$21.98
|
| Rate for Payer: BCBS Trust/PPO |
$14.03
|
| Rate for Payer: BCBS Trust/PPO |
$15.89
|
| Rate for Payer: BCBS Trust/PPO |
$15.79
|
| Rate for Payer: BCN Commercial |
$22.65
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: BCN Commercial |
$12.36
|
| Rate for Payer: BCN Commercial |
$14.03
|
| Rate for Payer: BCN Commercial |
$15.79
|
| Rate for Payer: BCN Commercial |
$21.98
|
| Rate for Payer: BCN Commercial |
$15.89
|
| Rate for Payer: BCN Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$23.45
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cash Price |
$16.45
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Cofinity Commercial |
$25.21
|
| Rate for Payer: Cofinity Commercial |
$17.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$14.39
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$26.38
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.77
|
| Rate for Payer: PHP Commercial |
$17.48
|
| Rate for Payer: PHP Commercial |
$13.59
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: PHP Commercial |
$24.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.98
|
| Rate for Payer: UHC Core |
$17.06
|
| Rate for Payer: UHC Core |
$15.16
|
| Rate for Payer: UHC Core |
$23.75
|
| Rate for Payer: UHC Core |
$20.41
|
| Rate for Payer: UHC Core |
$13.35
|
| Rate for Payer: UHC Core |
$17.50
|
| Rate for Payer: UHC Core |
$17.17
|
| Rate for Payer: UHC Core |
$24.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.62
|
|
|
SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET
|
Facility
IP
|
$2,275.50
|
|
|
Service Code
|
NDC 0078-0659-20
|
| Hospital Charge Code |
174639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,387.83 |
| Max. Negotiated Rate |
$2,047.95 |
| Rate for Payer: Aetna Commercial |
$1,934.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,758.51
|
| Rate for Payer: BCN Commercial |
$1,758.51
|
| Rate for Payer: Cash Price |
$1,820.40
|
| Rate for Payer: Cofinity Commercial |
$1,956.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,820.40
|
| Rate for Payer: Healthscope Commercial |
$2,047.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,706.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,934.18
|
| Rate for Payer: PHP Commercial |
$1,934.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,592.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,979.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,387.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,002.44
|
| Rate for Payer: UHC Core |
$1,900.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,706.62
|
|
