|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
IP
|
$1,881.96
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,309.84 |
| Max. Negotiated Rate |
$1,693.76 |
| Rate for Payer: Aetna Commercial |
$1,599.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,554.31
|
| Rate for Payer: BCN Commercial |
$1,554.31
|
| Rate for Payer: Cash Price |
$1,505.57
|
| Rate for Payer: Cofinity Commercial |
$1,618.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,505.57
|
| Rate for Payer: Healthscope Commercial |
$1,693.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,411.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,599.67
|
| Rate for Payer: Nomi Health Commercial |
$1,543.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,411.47
|
| Rate for Payer: PHP Commercial |
$1,599.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,637.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,309.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,656.12
|
| Rate for Payer: UHC Core |
$1,571.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,411.47
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$5.82
|
| Rate for Payer: BCN Commercial |
$5.82
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: BCN Medicare Advantage |
$1.76
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Mclaren Medicaid |
$1.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.85
|
| Rate for Payer: Meridian Medicaid |
$1.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PACE Senior Care Partners |
$1.67
|
| Rate for Payer: PACE SWMI |
$1.76
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Medicare |
$1.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: UHC Exchange |
$1.76
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$1.76
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458058010
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicaid |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$19.32
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicaid |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$5.82
|
| Rate for Payer: BCN Commercial |
$5.82
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna Commercial |
$5.99
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: BCBS MAPPO |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.80
|
| Rate for Payer: BCN Medicare Advantage |
$1.76
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.76
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Mclaren Medicaid |
$1.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.85
|
| Rate for Payer: Meridian Medicaid |
$1.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.99
|
| Rate for Payer: Nomi Health Commercial |
$5.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PACE Senior Care Partners |
$1.67
|
| Rate for Payer: PACE SWMI |
$1.76
|
| Rate for Payer: PHP Commercial |
$5.99
|
| Rate for Payer: PHP Medicare Advantage |
$1.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.13
|
| Rate for Payer: Priority Health Medicare |
$1.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.91
|
| Rate for Payer: Railroad Medicare Medicare |
$1.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.20
|
| Rate for Payer: UHC Core |
$5.89
|
| Rate for Payer: UHC Exchange |
$1.76
|
| Rate for Payer: UHC Medicaid |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$1.76
|
| Rate for Payer: UHCCP Medicaid |
$1.24
|
| Rate for Payer: VA VA |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 50458057810
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$124.83
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$112.35 |
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: BCBS Trust/PPO |
$103.10
|
| Rate for Payer: BCN Commercial |
$103.10
|
| Rate for Payer: Cash Price |
$99.86
|
| Rate for Payer: Cofinity Commercial |
$107.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.86
|
| Rate for Payer: Healthscope Commercial |
$112.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.11
|
| Rate for Payer: Nomi Health Commercial |
$102.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.62
|
| Rate for Payer: PHP Commercial |
$106.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.85
|
| Rate for Payer: UHC Core |
$104.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.62
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.57 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$40.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.87
|
| Rate for Payer: BCBS Complete |
$28.95
|
| Rate for Payer: BCBS MAPPO |
$39.10
|
| Rate for Payer: BCBS Trust/PPO |
$128.57
|
| Rate for Payer: BCN Commercial |
$128.57
|
| Rate for Payer: BCN Medicare Advantage |
$39.10
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.10
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.29
|
| Rate for Payer: Mclaren Medicaid |
$27.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.05
|
| Rate for Payer: Meridian Medicaid |
$28.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Nomi Health Commercial |
$128.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PACE Senior Care Partners |
$37.14
|
| Rate for Payer: PACE SWMI |
$39.10
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: PHP Medicare Advantage |
$39.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.06
|
| Rate for Payer: Priority Health Medicare |
$39.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.85
|
| Rate for Payer: Railroad Medicare Medicare |
$39.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.62
|
| Rate for Payer: UHC Core |
$130.59
|
| Rate for Payer: UHC Exchange |
$39.10
|
| Rate for Payer: UHC Medicaid |
$27.57
|
| Rate for Payer: UHC Medicare Advantage |
$39.10
|
| Rate for Payer: UHCCP Medicaid |
$27.57
|
| Rate for Payer: VA VA |
$39.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$156.39
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.85 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: BCBS Trust/PPO |
$129.16
|
| Rate for Payer: BCN Commercial |
$129.16
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: Nomi Health Commercial |
$128.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.29
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$136.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.62
|
| Rate for Payer: UHC Core |
$130.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$124.83
|
|
|
Service Code
|
NDC 65862064860
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$112.35 |
| Rate for Payer: Aetna Commercial |
$106.11
|
| Rate for Payer: Aetna Medicare |
$32.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.01
|
| Rate for Payer: BCBS Complete |
$23.11
|
| Rate for Payer: BCBS MAPPO |
$31.21
|
| Rate for Payer: BCBS Trust/PPO |
$102.62
|
| Rate for Payer: BCN Commercial |
$102.62
|
| Rate for Payer: BCN Medicare Advantage |
$31.21
|
| Rate for Payer: Cash Price |
$99.86
|
| Rate for Payer: Cofinity Commercial |
$107.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.21
|
| Rate for Payer: Healthscope Commercial |
$112.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.62
|
| Rate for Payer: Mclaren Medicaid |
$22.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.77
|
| Rate for Payer: Meridian Medicaid |
$23.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.11
|
| Rate for Payer: Nomi Health Commercial |
$102.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.62
|
| Rate for Payer: PACE Senior Care Partners |
$29.65
|
| Rate for Payer: PACE SWMI |
$31.21
|
| Rate for Payer: PHP Commercial |
$106.11
|
| Rate for Payer: PHP Medicare Advantage |
$31.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.60
|
| Rate for Payer: Priority Health Medicare |
$31.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.88
|
| Rate for Payer: Railroad Medicare Medicare |
$31.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.85
|
| Rate for Payer: UHC Core |
$104.23
|
| Rate for Payer: UHC Exchange |
$31.21
|
| Rate for Payer: UHC Medicaid |
$22.01
|
| Rate for Payer: UHC Medicare Advantage |
$31.21
|
| Rate for Payer: UHCCP Medicaid |
$22.01
|
| Rate for Payer: VA VA |
$31.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.62
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
OP
|
$279.08
|
|
|
Service Code
|
NDC 51991079306
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: Aetna Medicare |
$72.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.21
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCBS MAPPO |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$229.43
|
| Rate for Payer: BCN Commercial |
$229.43
|
| Rate for Payer: BCN Medicare Advantage |
$69.77
|
| 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: Health Alliance Plan Medicare Advantage |
$69.77
|
| Rate for Payer: Healthscope Commercial |
$251.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.31
|
| Rate for Payer: Mclaren Medicaid |
$49.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.26
|
| Rate for Payer: Meridian Medicaid |
$51.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.22
|
| Rate for Payer: Nomi Health Commercial |
$228.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.31
|
| Rate for Payer: PACE Senior Care Partners |
$66.28
|
| Rate for Payer: PACE SWMI |
$69.77
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: PHP Medicare Advantage |
$69.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.80
|
| Rate for Payer: Priority Health Medicare |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.24
|
| Rate for Payer: Railroad Medicare Medicare |
$69.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.59
|
| Rate for Payer: UHC Core |
$233.03
|
| Rate for Payer: UHC Exchange |
$69.77
|
| Rate for Payer: UHC Medicaid |
$49.20
|
| Rate for Payer: UHC Medicare Advantage |
$69.77
|
| Rate for Payer: UHCCP Medicaid |
$49.20
|
| Rate for Payer: VA VA |
$69.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.31
|
|
|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$279.08
|
|
|
Service Code
|
NDC 51991079306
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.24 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: BCBS Trust/PPO |
$230.49
|
| Rate for Payer: BCN Commercial |
$230.49
|
| 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 Commercial |
$237.22
|
| Rate for Payer: Nomi Health Commercial |
$228.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.31
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.24
|
| 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
|
$158.46
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.29 |
| Max. Negotiated Rate |
$142.61 |
| Rate for Payer: Aetna Commercial |
$134.69
|
| Rate for Payer: BCBS Trust/PPO |
$130.87
|
| Rate for Payer: BCN Commercial |
$130.87
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.77
|
| Rate for Payer: Healthscope Commercial |
$142.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.69
|
| Rate for Payer: Nomi Health Commercial |
$129.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.84
|
| Rate for Payer: PHP Commercial |
$134.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.44
|
| Rate for Payer: UHC Core |
$132.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.84
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$158.46
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$142.61 |
| Rate for Payer: Aetna Commercial |
$134.69
|
| Rate for Payer: Aetna Medicare |
$41.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.52
|
| Rate for Payer: BCBS Complete |
$29.33
|
| Rate for Payer: BCBS MAPPO |
$39.62
|
| Rate for Payer: BCBS Trust/PPO |
$130.27
|
| Rate for Payer: BCN Commercial |
$130.27
|
| Rate for Payer: BCN Medicare Advantage |
$39.62
|
| Rate for Payer: Cash Price |
$126.77
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.62
|
| Rate for Payer: Healthscope Commercial |
$142.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.84
|
| Rate for Payer: Mclaren Medicaid |
$27.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.60
|
| Rate for Payer: Meridian Medicaid |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.69
|
| Rate for Payer: Nomi Health Commercial |
$129.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.84
|
| Rate for Payer: PACE Senior Care Partners |
$37.63
|
| Rate for Payer: PACE SWMI |
$39.62
|
| Rate for Payer: PHP Commercial |
$134.69
|
| Rate for Payer: PHP Medicare Advantage |
$39.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.86
|
| Rate for Payer: Priority Health Medicare |
$40.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.29
|
| Rate for Payer: Railroad Medicare Medicare |
$39.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.44
|
| Rate for Payer: UHC Core |
$132.31
|
| Rate for Payer: UHC Exchange |
$39.62
|
| Rate for Payer: UHC Medicaid |
$27.94
|
| Rate for Payer: UHC Medicare Advantage |
$39.62
|
| Rate for Payer: UHCCP Medicaid |
$27.94
|
| Rate for Payer: VA VA |
$39.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.84
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.96
|
|
|
Service Code
|
NDC 55150022505
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.55
|
| Rate for Payer: BCBS Complete |
$3.88
|
| Rate for Payer: BCBS MAPPO |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.23
|
| Rate for Payer: BCN Commercial |
$17.23
|
| Rate for Payer: BCN Medicare Advantage |
$5.24
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.24
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.72
|
| Rate for Payer: Mclaren Medicaid |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.50
|
| Rate for Payer: Meridian Medicaid |
$3.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.82
|
| Rate for Payer: Nomi Health Commercial |
$17.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.72
|
| Rate for Payer: PACE Senior Care Partners |
$4.98
|
| Rate for Payer: PACE SWMI |
$5.24
|
| Rate for Payer: PHP Commercial |
$17.82
|
| Rate for Payer: PHP Medicare Advantage |
$5.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.24
|
| Rate for Payer: Priority Health Medicare |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.50
|
| Rate for Payer: UHC Exchange |
$5.24
|
| Rate for Payer: UHC Medicaid |
$3.70
|
| Rate for Payer: UHC Medicare Advantage |
$5.24
|
| Rate for Payer: UHCCP Medicaid |
$3.70
|
| Rate for Payer: VA VA |
$5.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.72
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.35
|
|
|
Service Code
|
NDC 43066000710
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$25.52 |
| Rate for Payer: Aetna Commercial |
$24.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.41
|
| Rate for Payer: BCN Commercial |
$23.41
|
| Rate for Payer: Cash Price |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$24.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.68
|
| Rate for Payer: Healthscope Commercial |
$25.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.10
|
| Rate for Payer: Nomi Health Commercial |
$23.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.26
|
| Rate for Payer: PHP Commercial |
$24.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.95
|
| Rate for Payer: UHC Core |
$23.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.26
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Medicare |
$6.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.53
|
| Rate for Payer: BCBS Complete |
$4.46
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCN Commercial |
$19.80
|
| Rate for Payer: BCN Medicare Advantage |
$6.02
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.02
|
| Rate for Payer: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| Rate for Payer: Mclaren Medicaid |
$4.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: Meridian Medicaid |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.07
|
| Rate for Payer: PACE Senior Care Partners |
$5.72
|
| Rate for Payer: PACE SWMI |
$6.02
|
| Rate for Payer: PHP Commercial |
$20.48
|
| Rate for Payer: PHP Medicare Advantage |
$6.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.77
|
| Rate for Payer: Railroad Medicare Medicare |
$6.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicaid |
$4.25
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| Rate for Payer: UHCCP Medicaid |
$4.25
|
| Rate for Payer: VA VA |
$6.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.12
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: Aetna Medicare |
$4.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS MAPPO |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$15.72
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: BCN Medicare Advantage |
$4.78
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.78
|
| Rate for Payer: Healthscope Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.34
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.02
|
| Rate for Payer: Meridian Medicaid |
$3.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.25
|
| Rate for Payer: Nomi Health Commercial |
$15.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.54
|
| Rate for Payer: PACE SWMI |
$4.78
|
| Rate for Payer: PHP Commercial |
$16.25
|
| Rate for Payer: PHP Medicare Advantage |
$4.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.63
|
| Rate for Payer: Priority Health Medicare |
$4.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: Railroad Medicare Medicare |
$4.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.83
|
| Rate for Payer: UHC Core |
$15.97
|
| Rate for Payer: UHC Exchange |
$4.78
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicare Advantage |
$4.78
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: VA VA |
$4.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.34
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
NDC 00143925001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$6.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.39
|
| Rate for Payer: BCBS Complete |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$5.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| Rate for Payer: BCN Commercial |
$19.43
|
| Rate for Payer: BCN Medicare Advantage |
$5.91
|
| Rate for Payer: Cash Price |
$18.91
|
| Rate for Payer: Cofinity Commercial |
$20.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.91
|
| Rate for Payer: Healthscope Commercial |
$21.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.73
|
| Rate for Payer: Mclaren Medicaid |
$4.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.21
|
| Rate for Payer: Meridian Medicaid |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.73
|
| Rate for Payer: PACE Senior Care Partners |
$5.61
|
| Rate for Payer: PACE SWMI |
$5.91
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: PHP Medicare Advantage |
$5.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.57
|
| Rate for Payer: Priority Health Medicare |
$5.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.45
|
| Rate for Payer: Railroad Medicare Medicare |
$5.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.80
|
| Rate for Payer: UHC Core |
$19.74
|
| Rate for Payer: UHC Exchange |
$5.91
|
| Rate for Payer: UHC Medicaid |
$4.17
|
| Rate for Payer: UHC Medicare Advantage |
$5.91
|
| Rate for Payer: UHCCP Medicaid |
$4.17
|
| Rate for Payer: VA VA |
$5.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.73
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.49
|
|
|
Service Code
|
NDC 00409318905
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.31
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: BCN Medicare Advantage |
$5.87
|
| 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: Health Alliance Plan Medicare Advantage |
$5.87
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Nomi Health Commercial |
$19.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.87
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Medicare Advantage |
$5.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.35
|
| Rate for Payer: Railroad Medicare Medicare |
$5.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Exchange |
$5.87
|
| Rate for Payer: UHC Medicaid |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$5.87
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: VA VA |
$5.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.15
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.92
|
| 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: Health Alliance Plan Medicare Advantage |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.75
|
| Rate for Payer: Mclaren Medicaid |
$3.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.16
|
| Rate for Payer: Meridian Medicaid |
$3.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.75
|
| Rate for Payer: PACE Senior Care Partners |
$4.67
|
| Rate for Payer: PACE SWMI |
$4.92
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: PHP Medicare Advantage |
$4.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.11
|
| Rate for Payer: Priority Health Medicare |
$4.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.69
|
| Rate for Payer: Railroad Medicare Medicare |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.31
|
| Rate for Payer: UHC Core |
$16.42
|
| Rate for Payer: UHC Exchange |
$4.92
|
| Rate for Payer: UHC Medicaid |
$3.47
|
| Rate for Payer: UHC Medicare Advantage |
$4.92
|
| Rate for Payer: UHCCP Medicaid |
$3.47
|
| Rate for Payer: VA VA |
$4.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.75
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.31
|
|
|
Service Code
|
NDC 47781061617
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$20.90
|
| Rate for Payer: BCN Commercial |
$20.90
|
| 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 Commercial |
$21.51
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.98
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.62
|
| 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
|
|
