|
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
|
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
|
$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
|
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 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
|
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 |
$8.03
|
| 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 |
$8.03
|
|
|
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
|
|
|
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 |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$8.80
|
| Rate for Payer: BCN Commercial |
$8.32
|
| Rate for Payer: BCN Medicare Advantage |
$2.67
|
| 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 |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| 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 |
$2.67
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Medicare Advantage |
$2.67
|
| 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 |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.42
|
| Rate for Payer: UHC Core |
$8.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.67
|
| Rate for Payer: UHC Exchange |
$2.67
|
| Rate for Payer: UHC Medicare Advantage |
$2.67
|
| Rate for Payer: VA VA |
$2.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.87
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$23.28 |
| Rate for Payer: Aetna Commercial |
$21.99
|
| Rate for Payer: Aetna Medicare |
$6.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.08
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS MAPPO |
$6.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: BCN Medicare Advantage |
$6.47
|
| 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: Health Alliance Plan Medicare Advantage |
$6.47
|
| Rate for Payer: Healthscope Commercial |
$23.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.99
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: PACE Senior Care Partners |
$6.14
|
| Rate for Payer: PACE SWMI |
$6.47
|
| Rate for Payer: PHP Commercial |
$21.99
|
| Rate for Payer: PHP Medicare Advantage |
$6.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health HMO/PPO |
$22.51
|
| Rate for Payer: Priority Health Medicare |
$6.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.77
|
| Rate for Payer: UHC Core |
$21.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.47
|
| Rate for Payer: UHC Exchange |
$6.47
|
| Rate for Payer: UHC Medicare Advantage |
$6.47
|
| Rate for Payer: VA VA |
$6.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.40
|
|
|
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
|
$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
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCN Commercial |
$13.64
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.38
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 00703239403
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.69
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: BCN Medicare Advantage |
$4.55
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: PACE Senior Care Partners |
$4.32
|
| Rate for Payer: PACE SWMI |
$4.55
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.55
|
| Rate for Payer: UHC Exchange |
$4.55
|
| Rate for Payer: UHC Medicare Advantage |
$4.55
|
| Rate for Payer: VA VA |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.64
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| 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 |
$9.46
|
| Rate for Payer: BCBS MAPPO |
$5.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| Rate for Payer: BCN Commercial |
$18.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| 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 Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO |
$20.57
|
| Rate for Payer: Priority Health Medicare |
$5.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| 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 Dual Complete DSNP |
$5.91
|
| Rate for Payer: UHC Exchange |
$5.91
|
| Rate for Payer: UHC Medicare Advantage |
$5.91
|
| 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
|
IP
|
$23.64
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$18.27
|
| 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: Healthscope Commercial |
$21.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO |
$20.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.80
|
| Rate for Payer: UHC Core |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.73
|
|
|
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 |
$5.61 |
| 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 |
$9.46
|
| Rate for Payer: BCBS MAPPO |
$5.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| Rate for Payer: BCN Commercial |
$18.38
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| 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 Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO |
$20.57
|
| Rate for Payer: Priority Health Medicare |
$5.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| 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 Dual Complete DSNP |
$5.91
|
| Rate for Payer: UHC Exchange |
$5.91
|
| Rate for Payer: UHC Medicare Advantage |
$5.91
|
| 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
|
IP
|
$18.21
|
|
|
Service Code
|
NDC 00703239403
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.07
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
NDC 43066000710
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO |
$20.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.31
|
|
|
Service Code
|
NDC 47781061617
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: Aetna Medicare |
$6.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.91
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS MAPPO |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.81
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$6.33
|
| 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: Health Alliance Plan Medicare Advantage |
$6.33
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PACE Senior Care Partners |
$6.01
|
| Rate for Payer: PACE SWMI |
$6.33
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: PHP Medicare Advantage |
$6.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health HMO/PPO |
$22.02
|
| Rate for Payer: Priority Health Medicare |
$6.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.96
|
| Rate for Payer: Railroad Medicare Medicare |
$6.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.27
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.33
|
| Rate for Payer: UHC Exchange |
$6.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.33
|
| Rate for Payer: VA VA |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
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 |
$16.45 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$20.66
|
| Rate for Payer: BCN Commercial |
$19.56
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$21.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.51
|
| Rate for Payer: Nomi Health Commercial |
$20.75
|
| Rate for Payer: PHP Commercial |
$21.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.45
|
| Rate for Payer: Priority Health HMO/PPO |
$22.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.27
|
| Rate for Payer: UHC Core |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.98
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 43066000710
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Aetna Commercial |
$20.40
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.50
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$18.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$20.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.00
|
| Rate for Payer: Healthscope Commercial |
$21.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: PACE Senior Care Partners |
$5.70
|
| Rate for Payer: PACE SWMI |
$6.00
|
| Rate for Payer: PHP Commercial |
$20.40
|
| Rate for Payer: PHP Medicare Advantage |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO |
$20.88
|
| Rate for Payer: Priority Health Medicare |
$6.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.12
|
| Rate for Payer: UHC Core |
$20.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.00
|
| Rate for Payer: UHC Exchange |
$6.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
| Rate for Payer: VA VA |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.00
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.32
|
| Rate for Payer: BCN Commercial |
$13.55
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
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
|
$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
|
$23.64
|
|
|
Service Code
|
NDC 00143925001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$21.28 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: BCBS Trust/PPO |
$19.30
|
| Rate for Payer: BCN Commercial |
$18.27
|
| 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: Healthscope Commercial |
$21.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$19.38
|
| Rate for Payer: PHP Commercial |
$20.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO |
$20.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.80
|
| Rate for Payer: UHC Core |
$19.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.73
|
|
