|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$6.35
|
|
|
Service Code
|
NDC 50458-578-30
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.91
|
| Rate for Payer: BCN Commercial |
$4.91
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.08
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.40
|
| Rate for Payer: PHP Commercial |
$5.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.59
|
| Rate for Payer: UHC Core |
$5.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.76
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$21.15
|
|
|
Service Code
|
NDC 50458-578-10
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$19.04 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCN Commercial |
$16.34
|
| Rate for Payer: Cash Price |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$18.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.92
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.98
|
| Rate for Payer: PHP Commercial |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.61
|
| Rate for Payer: UHC Core |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.86
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$148.32
|
|
|
Service Code
|
NDC 55111-352-60
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.46 |
| Max. Negotiated Rate |
$133.49 |
| Rate for Payer: Aetna Commercial |
$126.07
|
| Rate for Payer: BCBS Trust/PPO |
$114.62
|
| Rate for Payer: BCN Commercial |
$114.62
|
| Rate for Payer: Cash Price |
$118.66
|
| Rate for Payer: Cofinity Commercial |
$127.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.66
|
| Rate for Payer: Healthscope Commercial |
$133.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$126.07
|
| Rate for Payer: PHP Commercial |
$126.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.52
|
| Rate for Payer: UHC Core |
$123.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.24
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$127.68
|
|
|
Service Code
|
NDC 65862-648-60
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.87 |
| Max. Negotiated Rate |
$114.91 |
| Rate for Payer: Aetna Commercial |
$108.53
|
| Rate for Payer: BCBS Trust/PPO |
$98.67
|
| Rate for Payer: BCN Commercial |
$98.67
|
| Rate for Payer: Cash Price |
$102.14
|
| Rate for Payer: Cofinity Commercial |
$109.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.14
|
| Rate for Payer: Healthscope Commercial |
$114.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.53
|
| Rate for Payer: PHP Commercial |
$108.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.36
|
| Rate for Payer: UHC Core |
$106.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.76
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$279.08
|
|
|
Service Code
|
NDC 51991-793-06
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: BCBS Trust/PPO |
$215.67
|
| Rate for Payer: BCN Commercial |
$215.67
|
| Rate for Payer: Cash Price |
$223.26
|
| Rate for Payer: Cofinity Commercial |
$240.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.26
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.22
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.59
|
| Rate for Payer: UHC Core |
$233.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.31
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$279.08
|
|
|
Service Code
|
NDC 51991-794-06
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: BCBS Trust/PPO |
$215.67
|
| Rate for Payer: BCN Commercial |
$215.67
|
| Rate for Payer: Cash Price |
$223.26
|
| Rate for Payer: Cofinity Commercial |
$240.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.26
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.22
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.59
|
| Rate for Payer: UHC Core |
$233.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.31
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$170.43
|
|
|
Service Code
|
NDC 65862-649-60
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$153.39 |
| Rate for Payer: Aetna Commercial |
$144.87
|
| Rate for Payer: BCBS Trust/PPO |
$131.71
|
| Rate for Payer: BCN Commercial |
$131.71
|
| Rate for Payer: Cash Price |
$136.34
|
| Rate for Payer: Cofinity Commercial |
$146.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.34
|
| Rate for Payer: Healthscope Commercial |
$153.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$127.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$144.87
|
| Rate for Payer: PHP Commercial |
$144.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.98
|
| Rate for Payer: UHC Core |
$142.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$127.82
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$39.03
|
|
|
Service Code
|
NDC 47781-304-11
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: BCBS Trust/PPO |
$30.16
|
| Rate for Payer: BCN Commercial |
$30.16
|
| Rate for Payer: Cash Price |
$31.22
|
| Rate for Payer: Cofinity Commercial |
$33.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.22
|
| Rate for Payer: Healthscope Commercial |
$35.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.18
|
| Rate for Payer: PHP Commercial |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.35
|
| Rate for Payer: UHC Core |
$32.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.27
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.69
|
|
|
Service Code
|
NDC 0078-0501-61
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.99 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: BCBS Trust/PPO |
$60.81
|
| Rate for Payer: BCN Commercial |
$60.81
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.95
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.25
|
| Rate for Payer: UHC Core |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,170.83
|
|
|
Service Code
|
NDC 47781-304-03
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$714.09 |
| Max. Negotiated Rate |
$1,053.75 |
| Rate for Payer: Aetna Commercial |
$995.21
|
| Rate for Payer: BCBS Trust/PPO |
$904.82
|
| Rate for Payer: BCN Commercial |
$904.82
|
| Rate for Payer: Cash Price |
$936.66
|
| Rate for Payer: Cofinity Commercial |
$1,006.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.66
|
| Rate for Payer: Healthscope Commercial |
$1,053.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$995.21
|
| Rate for Payer: PHP Commercial |
$995.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$714.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,030.33
|
| Rate for Payer: UHC Core |
$977.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.12
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,360.53
|
|
|
Service Code
|
NDC 0078-0501-15
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,439.69 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,824.22
|
| Rate for Payer: BCN Commercial |
$1,824.22
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$2,030.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.42
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,652.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,053.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,439.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,077.27
|
| Rate for Payer: UHC Core |
$1,971.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$320.91
|
|
|
Service Code
|
NDC 47781-305-03
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.72 |
| Max. Negotiated Rate |
$288.82 |
| Rate for Payer: Aetna Commercial |
$272.77
|
| Rate for Payer: BCBS Trust/PPO |
$248.00
|
| Rate for Payer: BCN Commercial |
$248.00
|
| Rate for Payer: Cash Price |
$256.73
|
| Rate for Payer: Cofinity Commercial |
$275.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.73
|
| Rate for Payer: Healthscope Commercial |
$288.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.77
|
| Rate for Payer: PHP Commercial |
$272.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.40
|
| Rate for Payer: UHC Core |
$267.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.68
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$10.70
|
|
|
Service Code
|
NDC 47781-305-11
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$8.27
|
| Rate for Payer: BCN Commercial |
$8.27
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cofinity Commercial |
$9.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.10
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.42
|
| Rate for Payer: UHC Core |
$8.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.02
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.94
|
|
|
Service Code
|
NDC 72611-756-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.65 |
| Max. Negotiated Rate |
$26.05 |
| 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: UHC Core |
$24.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.63
|
|
|
Service Code
|
NDC 0143-9250-10
|
| 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
|
$15.99
|
|
|
Service Code
|
NDC 0781-3220-95
|
| Hospital Charge Code |
12734
|
|
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 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
|
$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: 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: UHC Core |
$24.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
|
|
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
|
$25.31
|
|
|
Service Code
|
NDC 47781-616-17
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$19.56
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.51
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.27
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-1403-05
|
| 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
|
$18.21
|
|
|
Service Code
|
NDC 0703-2394-03
|
| Hospital Charge Code |
12734
|
|
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
|
|
|
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
|
$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
|
$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
|
|
