|
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 IV (CODE)
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
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 |
$13.16
|
| 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 |
$13.16
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.87
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$27.50
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: BCBS Trust/PPO |
$22.45
|
| Rate for Payer: BCN Commercial |
$21.25
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$24.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Nomi Health Commercial |
$22.55
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health HMO/PPO |
$23.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.20
|
| Rate for Payer: UHC Core |
$22.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.62
|
|
|
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 |
$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
|
|
|
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 |
$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 IV (CODE)
|
Facility
|
OP
|
$25.39
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$27.50
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$23.38
|
| Rate for Payer: Aetna Medicare |
$7.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.59
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS MAPPO |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$22.61
|
| Rate for Payer: BCN Commercial |
$21.38
|
| Rate for Payer: BCN Medicare Advantage |
$6.88
|
| Rate for Payer: Cash Price |
$22.00
|
| Rate for Payer: Cofinity Commercial |
$23.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.88
|
| Rate for Payer: Healthscope Commercial |
$24.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.38
|
| Rate for Payer: Nomi Health Commercial |
$22.55
|
| Rate for Payer: PACE Senior Care Partners |
$6.53
|
| Rate for Payer: PACE SWMI |
$6.88
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Medicare Advantage |
$6.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.88
|
| Rate for Payer: Priority Health HMO/PPO |
$23.92
|
| Rate for Payer: Priority Health Medicare |
$6.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.20
|
| Rate for Payer: UHC Core |
$22.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.88
|
| Rate for Payer: UHC Exchange |
$6.88
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
| Rate for Payer: VA VA |
$6.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.62
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
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 |
$13.16
|
| 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 |
$13.16
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 00703239403
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$25.87
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
NDC 00703239403
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$19.67
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$25.39
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$22.85 |
| Rate for Payer: Aetna Commercial |
$21.58
|
| Rate for Payer: BCBS Trust/PPO |
$20.73
|
| Rate for Payer: BCN Commercial |
$19.62
|
| 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: PHP Commercial |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO |
$22.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.01
|
| 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 |
$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
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$222.05
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.33 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Aetna Commercial |
$188.74
|
| Rate for Payer: BCBS Trust/PPO |
$181.26
|
| Rate for Payer: BCN Commercial |
$171.60
|
| Rate for Payer: Cash Price |
$177.64
|
| Rate for Payer: Cofinity Commercial |
$190.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.64
|
| Rate for Payer: Healthscope Commercial |
$199.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.74
|
| Rate for Payer: Nomi Health Commercial |
$182.08
|
| Rate for Payer: PHP Commercial |
$188.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.33
|
| Rate for Payer: Priority Health HMO/PPO |
$193.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.40
|
| Rate for Payer: UHC Core |
$185.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: Aetna Medicare |
$385.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$463.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$463.81
|
| Rate for Payer: BCBS Complete |
$593.68
|
| Rate for Payer: BCBS MAPPO |
$371.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.15
|
| Rate for Payer: BCN Commercial |
$1,153.96
|
| Rate for Payer: BCN Medicare Advantage |
$371.05
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$426.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: Nomi Health Commercial |
$1,217.04
|
| Rate for Payer: PACE Senior Care Partners |
$352.50
|
| Rate for Payer: PACE SWMI |
$371.05
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: PHP Medicare Advantage |
$371.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,291.25
|
| Rate for Payer: Priority Health Medicare |
$374.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.41
|
| Rate for Payer: Railroad Medicare Medicare |
$371.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.09
|
| Rate for Payer: UHC Core |
$1,239.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.05
|
| Rate for Payer: UHC Exchange |
$371.05
|
| Rate for Payer: UHC Medicare Advantage |
$371.05
|
| Rate for Payer: VA VA |
$371.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.14
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,484.19
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$964.72 |
| Max. Negotiated Rate |
$1,335.77 |
| Rate for Payer: Aetna Commercial |
$1,261.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.54
|
| Rate for Payer: BCN Commercial |
$1,146.98
|
| Rate for Payer: Cash Price |
$1,187.35
|
| Rate for Payer: Cofinity Commercial |
$1,276.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,187.35
|
| Rate for Payer: Healthscope Commercial |
$1,335.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,113.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.56
|
| Rate for Payer: Nomi Health Commercial |
$1,217.04
|
| Rate for Payer: PHP Commercial |
$1,261.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$964.72
|
| Rate for Payer: Priority Health HMO/PPO |
$1,291.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$994.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.09
|
| Rate for Payer: UHC Core |
$1,239.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,113.14
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$222.05
|
|
|
Service Code
|
NDC 72205020090
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.74 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Aetna Commercial |
$188.74
|
| Rate for Payer: Aetna Medicare |
$57.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.39
|
| Rate for Payer: BCBS Complete |
$88.82
|
| Rate for Payer: BCBS MAPPO |
$55.51
|
| Rate for Payer: BCBS Trust/PPO |
$182.55
|
| Rate for Payer: BCN Commercial |
$172.64
|
| Rate for Payer: BCN Medicare Advantage |
$55.51
|
| Rate for Payer: Cash Price |
$177.64
|
| Rate for Payer: Cofinity Commercial |
$190.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.51
|
| Rate for Payer: Healthscope Commercial |
$199.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.74
|
| Rate for Payer: Nomi Health Commercial |
$182.08
|
| Rate for Payer: PACE Senior Care Partners |
$52.74
|
| Rate for Payer: PACE SWMI |
$55.51
|
| Rate for Payer: PHP Commercial |
$188.74
|
| Rate for Payer: PHP Medicare Advantage |
$55.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.33
|
| Rate for Payer: Priority Health HMO/PPO |
$193.18
|
| Rate for Payer: Priority Health Medicare |
$56.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.77
|
| Rate for Payer: Railroad Medicare Medicare |
$55.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.40
|
| Rate for Payer: UHC Core |
$185.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.51
|
| Rate for Payer: UHC Exchange |
$55.51
|
| Rate for Payer: UHC Medicare Advantage |
$55.51
|
| Rate for Payer: VA VA |
$55.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
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 |
$8.31 |
| 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 |
$8.72
|
| Rate for Payer: BCBS MAPPO |
$1,001.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,293.32
|
| Rate for Payer: BCN Commercial |
$3,114.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,001.50
|
| Rate for Payer: Cash Price |
$3,204.79
|
| 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 |
$8.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,051.57
|
| Rate for Payer: Meridian Medicaid |
$8.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.09
|
| Rate for Payer: Nomi Health Commercial |
$3,284.91
|
| 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 |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3,485.21
|
| Rate for Payer: Priority Health Medicare |
$1,011.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,684.01
|
| 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 Dual Complete DSNP |
$1,001.50
|
| Rate for Payer: UHC Exchange |
$1,001.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,001.50
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| 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 |
$2,603.89 |
| Max. Negotiated Rate |
$3,605.39 |
| Rate for Payer: Aetna Commercial |
$3,405.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,270.09
|
| Rate for Payer: BCN Commercial |
$3,095.83
|
| 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: PHP Commercial |
$3,405.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3,485.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,684.01
|
| 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
|
IP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.74 |
| Max. Negotiated Rate |
$300.10 |
| Rate for Payer: Aetna Commercial |
$283.43
|
| Rate for Payer: BCBS Trust/PPO |
$272.20
|
| Rate for Payer: BCN Commercial |
$257.69
|
| 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 |
$300.10
|
| 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: PHP Commercial |
$283.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.74
|
| Rate for Payer: Priority Health HMO/PPO |
$290.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.41
|
| 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
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.93 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$36.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.33
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$34.66
|
| Rate for Payer: BCBS Trust/PPO |
$113.98
|
| Rate for Payer: BCN Commercial |
$107.80
|
| Rate for Payer: BCN Medicare Advantage |
$34.66
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.66
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PACE Senior Care Partners |
$32.93
|
| Rate for Payer: PACE SWMI |
$34.66
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: PHP Medicare Advantage |
$34.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: Railroad Medicare Medicare |
$34.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.66
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UHC Medicare Advantage |
$34.66
|
| Rate for Payer: VA VA |
$34.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
ROPINIROLE 0.25 MG TABLET
|
Facility
|
OP
|
$333.45
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.19 |
| Max. Negotiated Rate |
$300.10 |
| 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 |
$133.38
|
| Rate for Payer: BCBS MAPPO |
$83.36
|
| Rate for Payer: BCBS Trust/PPO |
$274.13
|
| Rate for Payer: BCN Commercial |
$259.26
|
| 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 |
$300.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.43
|
| Rate for Payer: Nomi Health Commercial |
$273.43
|
| 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 Cigna Priority Health |
$216.74
|
| Rate for Payer: Priority Health HMO/PPO |
$290.10
|
| Rate for Payer: Priority Health Medicare |
$84.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.41
|
| 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 Dual Complete DSNP |
$83.36
|
| Rate for Payer: UHC Exchange |
$83.36
|
| Rate for Payer: UHC Medicare Advantage |
$83.36
|
| 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
|
$138.65
|
|
|
Service Code
|
NDC 43547026810
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.12 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: BCBS Trust/PPO |
$113.18
|
| Rate for Payer: BCN Commercial |
$107.15
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.12
|
| Rate for Payer: Priority Health HMO/PPO |
$120.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.01
|
| Rate for Payer: UHC Core |
$115.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
