|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.96
|
|
|
Service Code
|
NDC 55150022505
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.82
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCN Commercial |
$17.31
|
| 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: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.72
|
| 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: PHP Commercial |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.72
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.31
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.22
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS MAPPO |
$6.58
|
| Rate for Payer: BCBS Trust/PPO |
$21.63
|
| Rate for Payer: BCN Commercial |
$21.63
|
| Rate for Payer: BCN Medicare Advantage |
$6.58
|
| Rate for Payer: Cash Price |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$22.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.73
|
| Rate for Payer: Mclaren Medicaid |
$4.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.91
|
| Rate for Payer: Meridian Medicaid |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.36
|
| Rate for Payer: Nomi Health Commercial |
$21.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.73
|
| Rate for Payer: PACE Senior Care Partners |
$6.25
|
| Rate for Payer: PACE SWMI |
$6.58
|
| Rate for Payer: PHP Commercial |
$22.36
|
| Rate for Payer: PHP Medicare Advantage |
$6.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.89
|
| Rate for Payer: Priority Health Medicare |
$6.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.15
|
| Rate for Payer: UHC Core |
$21.97
|
| Rate for Payer: UHC Exchange |
$6.58
|
| Rate for Payer: UHC Medicaid |
$4.64
|
| Rate for Payer: UHC Medicare Advantage |
$6.58
|
| Rate for Payer: UHCCP Medicaid |
$4.64
|
| Rate for Payer: VA VA |
$6.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.73
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.31
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.73
|
| Rate for Payer: BCN Commercial |
$21.73
|
| Rate for Payer: Cash Price |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$22.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.05
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.36
|
| Rate for Payer: Nomi Health Commercial |
$21.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.73
|
| Rate for Payer: PHP Commercial |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.15
|
| Rate for Payer: UHC Core |
$21.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.73
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.90
|
| Rate for Payer: BCN Commercial |
$19.90
|
| 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: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| 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: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.97
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.04
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.90
|
| Rate for Payer: BCN Commercial |
$19.90
|
| 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: Healthscope Commercial |
$21.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.07
|
| 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: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.20
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.07
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$26.31
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: Aetna Medicare |
$6.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.22
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS MAPPO |
$6.58
|
| Rate for Payer: BCBS Trust/PPO |
$21.63
|
| Rate for Payer: BCN Commercial |
$21.63
|
| Rate for Payer: BCN Medicare Advantage |
$6.58
|
| Rate for Payer: Cash Price |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$22.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.58
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.73
|
| Rate for Payer: Mclaren Medicaid |
$4.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.91
|
| Rate for Payer: Meridian Medicaid |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.36
|
| Rate for Payer: Nomi Health Commercial |
$21.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.73
|
| Rate for Payer: PACE Senior Care Partners |
$6.25
|
| Rate for Payer: PACE SWMI |
$6.58
|
| Rate for Payer: PHP Commercial |
$22.36
|
| Rate for Payer: PHP Medicare Advantage |
$6.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.89
|
| Rate for Payer: Priority Health Medicare |
$6.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.31
|
| Rate for Payer: Railroad Medicare Medicare |
$6.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.15
|
| Rate for Payer: UHC Core |
$21.97
|
| Rate for Payer: UHC Exchange |
$6.58
|
| Rate for Payer: UHC Medicaid |
$4.64
|
| Rate for Payer: UHC Medicare Advantage |
$6.58
|
| Rate for Payer: UHCCP Medicaid |
$4.64
|
| Rate for Payer: VA VA |
$6.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.73
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: Aetna Medicare |
$6.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.93
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$20.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.35
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$21.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.35
|
| Rate for Payer: Healthscope Commercial |
$22.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.04
|
| Rate for Payer: Mclaren Medicaid |
$4.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: Meridian Medicaid |
$4.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.04
|
| Rate for Payer: PACE Senior Care Partners |
$6.03
|
| Rate for Payer: PACE SWMI |
$6.35
|
| Rate for Payer: PHP Commercial |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$6.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.34
|
| Rate for Payer: UHC Core |
$21.20
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicaid |
$4.48
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: UHCCP Medicaid |
$4.48
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$19.12
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$15.79
|
| Rate for Payer: BCN Commercial |
$15.79
|
| 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: Healthscope Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.34
|
| 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: PHP Commercial |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.83
|
| Rate for Payer: UHC Core |
$15.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.34
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$16.25
|
| Rate for Payer: BCN Commercial |
$16.25
|
| 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 Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.75
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.69
|
| 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
|
$26.31
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$23.68 |
| Rate for Payer: Aetna Commercial |
$22.36
|
| Rate for Payer: BCBS Trust/PPO |
$21.73
|
| Rate for Payer: BCN Commercial |
$21.73
|
| Rate for Payer: Cash Price |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$22.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.05
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.36
|
| Rate for Payer: Nomi Health Commercial |
$21.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.73
|
| Rate for Payer: PHP Commercial |
$22.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.15
|
| Rate for Payer: UHC Core |
$21.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.73
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$19.12
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
163721
|
|
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
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$225.94
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$203.35 |
| Rate for Payer: Aetna Commercial |
$192.05
|
| Rate for Payer: Aetna Medicare |
$58.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.61
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$56.48
|
| Rate for Payer: BCBS Trust/PPO |
$185.75
|
| Rate for Payer: BCN Commercial |
$185.75
|
| Rate for Payer: BCN Medicare Advantage |
$56.48
|
| Rate for Payer: Cash Price |
$180.75
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.48
|
| Rate for Payer: Healthscope Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.46
|
| Rate for Payer: Mclaren Medicaid |
$39.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.31
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.05
|
| Rate for Payer: Nomi Health Commercial |
$185.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.46
|
| Rate for Payer: PACE Senior Care Partners |
$53.66
|
| Rate for Payer: PACE SWMI |
$56.48
|
| Rate for Payer: PHP Commercial |
$192.05
|
| Rate for Payer: PHP Medicare Advantage |
$56.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$196.57
|
| Rate for Payer: Priority Health Medicare |
$57.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.25
|
| Rate for Payer: Railroad Medicare Medicare |
$56.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.83
|
| Rate for Payer: UHC Core |
$188.66
|
| Rate for Payer: UHC Exchange |
$56.48
|
| Rate for Payer: UHC Medicaid |
$39.83
|
| Rate for Payer: UHC Medicare Advantage |
$56.48
|
| Rate for Payer: UHCCP Medicaid |
$39.83
|
| Rate for Payer: VA VA |
$56.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.46
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,528.81
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,064.05 |
| Max. Negotiated Rate |
$1,375.93 |
| Rate for Payer: Aetna Commercial |
$1,299.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.64
|
| Rate for Payer: BCN Commercial |
$1,262.64
|
| Rate for Payer: Cash Price |
$1,223.05
|
| Rate for Payer: Cofinity Commercial |
$1,314.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.05
|
| Rate for Payer: Healthscope Commercial |
$1,375.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,146.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.49
|
| Rate for Payer: Nomi Health Commercial |
$1,253.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.61
|
| Rate for Payer: PHP Commercial |
$1,299.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,330.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,345.35
|
| Rate for Payer: UHC Core |
$1,276.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,146.61
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,528.81
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.53 |
| Max. Negotiated Rate |
$1,375.93 |
| Rate for Payer: Aetna Commercial |
$1,299.49
|
| Rate for Payer: Aetna Medicare |
$397.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$477.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$477.75
|
| Rate for Payer: BCBS Complete |
$282.98
|
| Rate for Payer: BCBS MAPPO |
$382.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.83
|
| Rate for Payer: BCN Commercial |
$1,256.83
|
| Rate for Payer: BCN Medicare Advantage |
$382.20
|
| Rate for Payer: Cash Price |
$1,223.05
|
| Rate for Payer: Cofinity Commercial |
$1,314.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.20
|
| Rate for Payer: Healthscope Commercial |
$1,375.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,146.61
|
| Rate for Payer: Mclaren Medicaid |
$269.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.31
|
| Rate for Payer: Meridian Medicaid |
$282.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$439.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$420.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.49
|
| Rate for Payer: Nomi Health Commercial |
$1,253.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.61
|
| Rate for Payer: PACE Senior Care Partners |
$363.09
|
| Rate for Payer: PACE SWMI |
$382.20
|
| Rate for Payer: PHP Commercial |
$1,299.49
|
| Rate for Payer: PHP Medicare Advantage |
$382.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,330.06
|
| Rate for Payer: Priority Health Medicare |
$386.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.05
|
| Rate for Payer: Railroad Medicare Medicare |
$382.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,345.35
|
| Rate for Payer: UHC Core |
$1,276.56
|
| Rate for Payer: UHC Exchange |
$382.20
|
| Rate for Payer: UHC Medicaid |
$269.53
|
| Rate for Payer: UHC Medicare Advantage |
$382.20
|
| Rate for Payer: UHCCP Medicaid |
$269.53
|
| Rate for Payer: VA VA |
$382.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,146.61
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$225.94
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$203.35 |
| Rate for Payer: Aetna Commercial |
$192.05
|
| Rate for Payer: BCBS Trust/PPO |
$186.60
|
| Rate for Payer: BCN Commercial |
$186.60
|
| Rate for Payer: Cash Price |
$180.75
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.75
|
| Rate for Payer: Healthscope Commercial |
$203.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.05
|
| Rate for Payer: Nomi Health Commercial |
$185.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.46
|
| Rate for Payer: PHP Commercial |
$192.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$196.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.83
|
| Rate for Payer: UHC Core |
$188.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.46
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$706.26 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: Aetna Medicare |
$1,041.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,251.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,251.87
|
| Rate for Payer: BCBS Complete |
$741.51
|
| Rate for Payer: BCBS MAPPO |
$1,001.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,293.32
|
| Rate for Payer: BCN Commercial |
$3,293.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,001.50
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,001.50
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Mclaren Medicaid |
$706.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,051.57
|
| Rate for Payer: Meridian Medicaid |
$741.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,151.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,101.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$3,284.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,004.49
|
| Rate for Payer: PACE Senior Care Partners |
$951.42
|
| Rate for Payer: PACE SWMI |
$1,001.50
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,001.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$706.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,485.21
|
| Rate for Payer: Priority Health Medicare |
$1,011.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,788.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,001.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,525.27
|
| Rate for Payer: UHC Core |
$3,345.00
|
| Rate for Payer: UHC Exchange |
$1,001.50
|
| Rate for Payer: UHC Medicaid |
$706.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,001.50
|
| Rate for Payer: UHCCP Medicaid |
$706.26
|
| Rate for Payer: VA VA |
$1,001.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,005.99
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,788.17 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,308.55
|
| Rate for Payer: BCN Commercial |
$3,308.55
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,445.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.79
|
| Rate for Payer: Healthscope Commercial |
$3,605.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$3,284.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,004.49
|
| Rate for Payer: PHP Commercial |
$3,405.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,485.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,788.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,525.27
|
| Rate for Payer: UHC Core |
$3,345.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.49
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$31.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.45
|
| Rate for Payer: BCBS Complete |
$22.18
|
| Rate for Payer: BCBS MAPPO |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$98.53
|
| Rate for Payer: BCN Commercial |
$98.53
|
| Rate for Payer: BCN Medicare Advantage |
$29.96
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.96
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Mclaren Medicaid |
$21.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.46
|
| Rate for Payer: Meridian Medicaid |
$22.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Nomi Health Commercial |
$98.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PACE Senior Care Partners |
$28.46
|
| Rate for Payer: PACE SWMI |
$29.96
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: PHP Medicare Advantage |
$29.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.27
|
| Rate for Payer: Priority Health Medicare |
$30.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.42
|
| Rate for Payer: Railroad Medicare Medicare |
$29.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.47
|
| Rate for Payer: UHC Core |
$100.07
|
| Rate for Payer: UHC Exchange |
$29.96
|
| Rate for Payer: UHC Medicaid |
$21.13
|
| Rate for Payer: UHC Medicare Advantage |
$29.96
|
| Rate for Payer: UHCCP Medicaid |
$21.13
|
| Rate for Payer: VA VA |
$29.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.79 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: Aetna Medicare |
$86.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.20
|
| Rate for Payer: BCBS Complete |
$61.72
|
| Rate for Payer: BCBS MAPPO |
$83.36
|
| Rate for Payer: BCBS Trust/PPO |
$274.13
|
| Rate for Payer: BCN Commercial |
$274.13
|
| Rate for Payer: BCN Medicare Advantage |
$83.36
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.36
|
| Rate for Payer: Healthscope Commercial |
$300.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.09
|
| Rate for Payer: Mclaren Medicaid |
$58.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.53
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Nomi Health Commercial |
$273.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.09
|
| Rate for Payer: PACE Senior Care Partners |
$79.19
|
| Rate for Payer: PACE SWMI |
$83.36
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: PHP Medicare Advantage |
$83.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.10
|
| Rate for Payer: Priority Health Medicare |
$84.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.08
|
| Rate for Payer: Railroad Medicare Medicare |
$83.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.44
|
| Rate for Payer: UHC Core |
$278.43
|
| Rate for Payer: UHC Exchange |
$83.36
|
| Rate for Payer: UHC Medicaid |
$58.79
|
| Rate for Payer: UHC Medicare Advantage |
$83.36
|
| Rate for Payer: UHCCP Medicaid |
$58.79
|
| Rate for Payer: VA VA |
$83.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.09
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.08 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: BCBS Trust/PPO |
$275.40
|
| Rate for Payer: BCN Commercial |
$275.40
|
| Rate for Payer: Cash Price |
$266.76
|
| Rate for Payer: Cofinity Commercial |
$286.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.76
|
| Rate for Payer: Healthscope Commercial |
$300.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Nomi Health Commercial |
$273.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.09
|
| Rate for Payer: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$290.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.44
|
| Rate for Payer: UHC Core |
$278.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.09
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.42 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: BCBS Trust/PPO |
$98.98
|
| Rate for Payer: BCN Commercial |
$98.98
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Nomi Health Commercial |
$98.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$104.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.47
|
| Rate for Payer: UHC Core |
$100.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
