|
RIVASTIGMINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$159.56
|
|
|
Service Code
|
NDC 55111035260
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$143.60 |
| Rate for Payer: Aetna Commercial |
$135.63
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCN Commercial |
$123.31
|
| Rate for Payer: Cash Price |
$127.65
|
| Rate for Payer: Cofinity Commercial |
$137.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.65
|
| Rate for Payer: Healthscope Commercial |
$143.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$119.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.63
|
| Rate for Payer: Nomi Health Commercial |
$130.84
|
| Rate for Payer: PHP Commercial |
$135.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.71
|
| Rate for Payer: Priority Health HMO/PPO |
$138.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.41
|
| Rate for Payer: UHC Core |
$133.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$119.67
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$279.08
|
|
|
Service Code
|
NDC 51991079406
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.40 |
| Max. Negotiated Rate |
$251.17 |
| Rate for Payer: Aetna Commercial |
$237.22
|
| Rate for Payer: BCBS Trust/PPO |
$227.81
|
| 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 Commercial |
$237.22
|
| Rate for Payer: Nomi Health Commercial |
$228.85
|
| Rate for Payer: PHP Commercial |
$237.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.40
|
| Rate for Payer: Priority Health HMO/PPO |
$242.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.98
|
| 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
|
OP
|
$279.08
|
|
|
Service Code
|
NDC 51991079406
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.28 |
| 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 |
$111.63
|
| Rate for Payer: BCBS MAPPO |
$69.77
|
| Rate for Payer: BCBS Trust/PPO |
$229.43
|
| Rate for Payer: BCN Commercial |
$216.98
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.22
|
| Rate for Payer: Nomi Health Commercial |
$228.85
|
| 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 Cigna Priority Health |
$181.40
|
| Rate for Payer: Priority Health HMO/PPO |
$242.80
|
| Rate for Payer: Priority Health Medicare |
$70.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.98
|
| 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 Dual Complete DSNP |
$69.77
|
| Rate for Payer: UHC Exchange |
$69.77
|
| Rate for Payer: UHC Medicare Advantage |
$69.77
|
| Rate for Payer: VA VA |
$69.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.31
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$175.56
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.11 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: BCBS Trust/PPO |
$143.31
|
| Rate for Payer: BCN Commercial |
$135.67
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: Nomi Health Commercial |
$143.96
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.11
|
| Rate for Payer: Priority Health HMO/PPO |
$152.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.49
|
| Rate for Payer: UHC Core |
$146.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.67
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$175.56
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna Medicare |
$45.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.86
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$43.89
|
| Rate for Payer: BCBS Trust/PPO |
$144.33
|
| Rate for Payer: BCN Commercial |
$136.50
|
| Rate for Payer: BCN Medicare Advantage |
$43.89
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.89
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: Nomi Health Commercial |
$143.96
|
| Rate for Payer: PACE Senior Care Partners |
$41.70
|
| Rate for Payer: PACE SWMI |
$43.89
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: PHP Medicare Advantage |
$43.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.11
|
| Rate for Payer: Priority Health HMO/PPO |
$152.74
|
| Rate for Payer: Priority Health Medicare |
$44.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.63
|
| Rate for Payer: Railroad Medicare Medicare |
$43.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.49
|
| Rate for Payer: UHC Core |
$146.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.89
|
| Rate for Payer: UHC Exchange |
$43.89
|
| Rate for Payer: UHC Medicare Advantage |
$43.89
|
| Rate for Payer: VA VA |
$43.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.67
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,360.53
|
|
|
Service Code
|
NDC 00078050115
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,534.34 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.90
|
| 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 Commercial |
$2,006.45
|
| Rate for Payer: Nomi Health Commercial |
$1,935.63
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,053.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,581.56
|
| 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 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$39.03
|
|
|
Service Code
|
NDC 47781030411
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: BCBS Trust/PPO |
$31.86
|
| 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 Commercial |
$33.18
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: PHP Commercial |
$33.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.37
|
| Rate for Payer: Priority Health HMO/PPO |
$33.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.15
|
| 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 00078050161
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.15 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: BCBS Trust/PPO |
$64.23
|
| 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 Commercial |
$66.89
|
| Rate for Payer: Nomi Health Commercial |
$64.53
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.15
|
| Rate for Payer: Priority Health HMO/PPO |
$68.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.72
|
| 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
|
OP
|
$78.69
|
|
|
Service Code
|
NDC 00078050161
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna Medicare |
$20.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.59
|
| Rate for Payer: BCBS Complete |
$31.48
|
| Rate for Payer: BCBS MAPPO |
$19.67
|
| Rate for Payer: BCBS Trust/PPO |
$64.69
|
| Rate for Payer: BCN Commercial |
$61.18
|
| Rate for Payer: BCN Medicare Advantage |
$19.67
|
| 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: Health Alliance Plan Medicare Advantage |
$19.67
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.89
|
| Rate for Payer: Nomi Health Commercial |
$64.53
|
| Rate for Payer: PACE Senior Care Partners |
$18.69
|
| Rate for Payer: PACE SWMI |
$19.67
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: PHP Medicare Advantage |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.15
|
| Rate for Payer: Priority Health HMO/PPO |
$68.46
|
| Rate for Payer: Priority Health Medicare |
$19.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.72
|
| Rate for Payer: Railroad Medicare Medicare |
$19.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.25
|
| Rate for Payer: UHC Core |
$65.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.67
|
| Rate for Payer: UHC Exchange |
$19.67
|
| Rate for Payer: UHC Medicare Advantage |
$19.67
|
| Rate for Payer: VA VA |
$19.67
|
| 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 47781030403
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$761.04 |
| Max. Negotiated Rate |
$1,053.75 |
| Rate for Payer: Aetna Commercial |
$995.21
|
| Rate for Payer: BCBS Trust/PPO |
$955.75
|
| 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 Commercial |
$995.21
|
| Rate for Payer: Nomi Health Commercial |
$960.08
|
| Rate for Payer: PHP Commercial |
$995.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,018.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$784.46
|
| 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
|
OP
|
$1,170.83
|
|
|
Service Code
|
NDC 47781030403
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.07 |
| Max. Negotiated Rate |
$1,053.75 |
| Rate for Payer: Aetna Commercial |
$995.21
|
| Rate for Payer: Aetna Medicare |
$304.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$365.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$365.88
|
| Rate for Payer: BCBS Complete |
$468.33
|
| Rate for Payer: BCBS MAPPO |
$292.71
|
| Rate for Payer: BCBS Trust/PPO |
$962.54
|
| Rate for Payer: BCN Commercial |
$910.32
|
| Rate for Payer: BCN Medicare Advantage |
$292.71
|
| 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: Health Alliance Plan Medicare Advantage |
$292.71
|
| Rate for Payer: Healthscope Commercial |
$1,053.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$995.21
|
| Rate for Payer: Nomi Health Commercial |
$960.08
|
| Rate for Payer: PACE Senior Care Partners |
$278.07
|
| Rate for Payer: PACE SWMI |
$292.71
|
| Rate for Payer: PHP Commercial |
$995.21
|
| Rate for Payer: PHP Medicare Advantage |
$292.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$761.04
|
| Rate for Payer: Priority Health HMO/PPO |
$1,018.62
|
| Rate for Payer: Priority Health Medicare |
$295.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$784.46
|
| Rate for Payer: Railroad Medicare Medicare |
$292.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,030.33
|
| Rate for Payer: UHC Core |
$977.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.71
|
| Rate for Payer: UHC Exchange |
$292.71
|
| Rate for Payer: UHC Medicare Advantage |
$292.71
|
| Rate for Payer: VA VA |
$292.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.12
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$39.03
|
|
|
Service Code
|
NDC 47781030411
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$35.13 |
| Rate for Payer: Aetna Commercial |
$33.18
|
| Rate for Payer: Aetna Medicare |
$10.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.20
|
| Rate for Payer: BCBS Complete |
$15.61
|
| Rate for Payer: BCBS MAPPO |
$9.76
|
| Rate for Payer: BCBS Trust/PPO |
$32.09
|
| Rate for Payer: BCN Commercial |
$30.35
|
| Rate for Payer: BCN Medicare Advantage |
$9.76
|
| 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: Health Alliance Plan Medicare Advantage |
$9.76
|
| Rate for Payer: Healthscope Commercial |
$35.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.18
|
| Rate for Payer: Nomi Health Commercial |
$32.00
|
| Rate for Payer: PACE Senior Care Partners |
$9.27
|
| Rate for Payer: PACE SWMI |
$9.76
|
| Rate for Payer: PHP Commercial |
$33.18
|
| Rate for Payer: PHP Medicare Advantage |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.37
|
| Rate for Payer: Priority Health HMO/PPO |
$33.96
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.15
|
| Rate for Payer: Railroad Medicare Medicare |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.35
|
| Rate for Payer: UHC Core |
$32.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.76
|
| Rate for Payer: UHC Exchange |
$9.76
|
| Rate for Payer: UHC Medicare Advantage |
$9.76
|
| Rate for Payer: VA VA |
$9.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.27
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$2,360.53
|
|
|
Service Code
|
NDC 00078050115
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$560.63 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna Medicare |
$613.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$737.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$737.67
|
| Rate for Payer: BCBS Complete |
$944.21
|
| Rate for Payer: BCBS MAPPO |
$590.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,940.59
|
| Rate for Payer: BCN Commercial |
$1,835.31
|
| Rate for Payer: BCN Medicare Advantage |
$590.13
|
| 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: Health Alliance Plan Medicare Advantage |
$590.13
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$678.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.45
|
| Rate for Payer: Nomi Health Commercial |
$1,935.63
|
| Rate for Payer: PACE Senior Care Partners |
$560.63
|
| Rate for Payer: PACE SWMI |
$590.13
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: PHP Medicare Advantage |
$590.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.34
|
| Rate for Payer: Priority Health HMO/PPO |
$2,053.66
|
| Rate for Payer: Priority Health Medicare |
$596.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,581.56
|
| Rate for Payer: Railroad Medicare Medicare |
$590.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,077.27
|
| Rate for Payer: UHC Core |
$1,971.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$590.13
|
| Rate for Payer: UHC Exchange |
$590.13
|
| Rate for Payer: UHC Medicare Advantage |
$590.13
|
| Rate for Payer: VA VA |
$590.13
|
| 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 47781030503
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.59 |
| Max. Negotiated Rate |
$288.82 |
| Rate for Payer: Aetna Commercial |
$272.77
|
| Rate for Payer: BCBS Trust/PPO |
$261.96
|
| 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 Commercial |
$272.77
|
| Rate for Payer: Nomi Health Commercial |
$263.15
|
| Rate for Payer: PHP Commercial |
$272.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.59
|
| Rate for Payer: Priority Health HMO/PPO |
$279.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.01
|
| 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
|
OP
|
$10.70
|
|
|
Service Code
|
NDC 47781030511
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Medicare |
$2.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.34
|
| Rate for Payer: BCBS Complete |
$4.28
|
| Rate for Payer: BCBS MAPPO |
$2.68
|
| Rate for Payer: BCBS Trust/PPO |
$8.80
|
| Rate for Payer: BCN Commercial |
$8.32
|
| Rate for Payer: BCN Medicare Advantage |
$2.68
|
| 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: Health Alliance Plan Medicare Advantage |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Nomi Health Commercial |
$8.77
|
| Rate for Payer: PACE Senior Care Partners |
$2.54
|
| Rate for Payer: PACE SWMI |
$2.68
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Medicare Advantage |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.96
|
| Rate for Payer: Priority Health HMO/PPO |
$9.31
|
| Rate for Payer: Priority Health Medicare |
$2.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.42
|
| Rate for Payer: UHC Core |
$8.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.68
|
| Rate for Payer: UHC Exchange |
$2.68
|
| Rate for Payer: UHC Medicare Advantage |
$2.68
|
| Rate for Payer: VA VA |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.02
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$10.70
|
|
|
Service Code
|
NDC 47781030511
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$8.73
|
| 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 Commercial |
$9.10
|
| Rate for Payer: Nomi Health Commercial |
$8.77
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.96
|
| Rate for Payer: Priority Health HMO/PPO |
$9.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.17
|
| 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
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$320.91
|
|
|
Service Code
|
NDC 47781030503
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.22 |
| Max. Negotiated Rate |
$288.82 |
| Rate for Payer: Aetna Commercial |
$272.77
|
| Rate for Payer: Aetna Medicare |
$83.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.28
|
| Rate for Payer: BCBS Complete |
$128.36
|
| Rate for Payer: BCBS MAPPO |
$80.23
|
| Rate for Payer: BCBS Trust/PPO |
$263.82
|
| Rate for Payer: BCN Commercial |
$249.51
|
| Rate for Payer: BCN Medicare Advantage |
$80.23
|
| 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: Health Alliance Plan Medicare Advantage |
$80.23
|
| Rate for Payer: Healthscope Commercial |
$288.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.77
|
| Rate for Payer: Nomi Health Commercial |
$263.15
|
| Rate for Payer: PACE Senior Care Partners |
$76.22
|
| Rate for Payer: PACE SWMI |
$80.23
|
| Rate for Payer: PHP Commercial |
$272.77
|
| Rate for Payer: PHP Medicare Advantage |
$80.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.59
|
| Rate for Payer: Priority Health HMO/PPO |
$279.19
|
| Rate for Payer: Priority Health Medicare |
$81.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.01
|
| Rate for Payer: Railroad Medicare Medicare |
$80.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.40
|
| Rate for Payer: UHC Core |
$267.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.23
|
| Rate for Payer: UHC Exchange |
$80.23
|
| Rate for Payer: UHC Medicare Advantage |
$80.23
|
| Rate for Payer: VA VA |
$80.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.68
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$21.68 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: BCBS Trust/PPO |
$19.66
|
| Rate for Payer: BCN Commercial |
$18.62
|
| 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: PHP Commercial |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| 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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28.94
|
|
|
Service Code
|
NDC 72611075601
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$26.05 |
| Rate for Payer: Aetna Commercial |
$24.60
|
| Rate for Payer: Aetna Medicare |
$7.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.04
|
| Rate for Payer: BCBS Complete |
$11.58
|
| Rate for Payer: BCBS MAPPO |
$7.24
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: BCN Medicare Advantage |
$7.24
|
| 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: Health Alliance Plan Medicare Advantage |
$7.24
|
| Rate for Payer: Healthscope Commercial |
$26.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.60
|
| Rate for Payer: Nomi Health Commercial |
$23.73
|
| Rate for Payer: PACE Senior Care Partners |
$6.87
|
| Rate for Payer: PACE SWMI |
$7.24
|
| Rate for Payer: PHP Commercial |
$24.60
|
| Rate for Payer: PHP Medicare Advantage |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.81
|
| Rate for Payer: Priority Health HMO/PPO |
$25.18
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.39
|
| Rate for Payer: Railroad Medicare Medicare |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.47
|
| Rate for Payer: UHC Core |
$24.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.24
|
| Rate for Payer: UHC Exchange |
$7.24
|
| Rate for Payer: UHC Medicare Advantage |
$7.24
|
| Rate for Payer: VA VA |
$7.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.72 |
| 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 |
$9.64
|
| Rate for Payer: BCBS MAPPO |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.80
|
| Rate for Payer: BCN Commercial |
$18.73
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| 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 Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$6.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.14
|
| 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 Dual Complete DSNP |
$6.02
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$6.02
|
| 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
|
IP
|
$25.87
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$21.99
|
| Rate for Payer: BCBS Trust/PPO |
$21.12
|
| Rate for Payer: BCN Commercial |
$19.99
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.99
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: PHP Commercial |
$21.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO |
$22.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$21.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.40
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.03 |
| 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 |
$10.16
|
| Rate for Payer: BCBS MAPPO |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.87
|
| Rate for Payer: BCN Commercial |
$19.74
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.58
|
| Rate for Payer: Nomi Health Commercial |
$20.82
|
| 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 Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| 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 Dual Complete DSNP |
$6.35
|
| Rate for Payer: UHC Exchange |
$6.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.35
|
| Rate for Payer: VA VA |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.04
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.49
|
|
|
Service Code
|
NDC 00409140310
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.58 |
| 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 |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.31
|
| Rate for Payer: BCN Commercial |
$18.26
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Nomi Health Commercial |
$19.26
|
| 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 Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| 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 Dual Complete DSNP |
$5.87
|
| Rate for Payer: UHC Exchange |
$5.87
|
| Rate for Payer: UHC Medicare Advantage |
$5.87
|
| 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 |
$4.67 |
| 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 |
$7.87
|
| Rate for Payer: BCBS MAPPO |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$15.29
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| 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 Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health HMO/PPO |
$17.11
|
| Rate for Payer: Priority Health Medicare |
$4.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.18
|
| 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 Dual Complete DSNP |
$4.92
|
| Rate for Payer: UHC Exchange |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$4.92
|
| 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
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$17.70 |
| Rate for Payer: Aetna Commercial |
$16.72
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$17.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.72
|
| Rate for Payer: Nomi Health Commercial |
$16.13
|
| Rate for Payer: PHP Commercial |
$16.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.79
|
| Rate for Payer: Priority Health HMO/PPO |
$17.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.18
|
| 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
|
|
