|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.69
|
|
|
Service Code
|
NDC 0078-0502-61
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna American Axle |
$51.15
|
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.08
|
| Rate for Payer: Priority Health SBD |
$49.57
|
| Rate for Payer: UMR Bronson Commercial |
$34.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,360.53
|
|
|
Service Code
|
NDC 0078-0502-15
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,038.63 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna American Axle |
$1,534.34
|
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.34
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$1,652.37
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$1,652.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,652.37
|
| Rate for Payer: Priority Health SBD |
$1,487.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,038.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
IP
|
$121.05
|
|
|
Service Code
|
NDC 23155-245-46
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.26 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$102.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: Cash Price |
$96.84
|
| Rate for Payer: Cofinity Commercial |
$104.10
|
| Rate for Payer: Cofinity Commercial |
$84.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.84
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$102.89
|
| Rate for Payer: PHP Commercial |
$102.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.74
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UMR Bronson Commercial |
$53.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.79
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
IP
|
$6.73
|
|
|
Service Code
|
NDC 23155-245-22
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna American Axle |
$4.37
|
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Commercial |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.72
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.71
|
| Rate for Payer: Priority Health SBD |
$4.24
|
| Rate for Payer: UMR Bronson Commercial |
$2.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.53
|
|
|
Service Code
|
NDC 0781-3220-92
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$26.58 |
| Rate for Payer: Aetna American Axle |
$19.19
|
| Rate for Payer: Aetna Commercial |
$25.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.19
|
| Rate for Payer: Cash Price |
$23.62
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Commercial |
$25.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$26.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.10
|
| Rate for Payer: PHP Commercial |
$25.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.67
|
| Rate for Payer: Priority Health SBD |
$18.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.14
|
|
|
Service Code
|
NDC 71839-141-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Aetna American Axle |
$9.84
|
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.84
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.87
|
| Rate for Payer: PHP Commercial |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$6.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.72
|
|
|
Service Code
|
NDC 55150-226-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$24.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.71
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health SBD |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.17
|
|
|
Service Code
|
NDC 72572-651-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna American Axle |
$14.41
|
| Rate for Payer: Aetna Commercial |
$18.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.41
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$19.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.84
|
| Rate for Payer: PHP Commercial |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health SBD |
$13.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.63
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-3189-05
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna American Axle |
$15.27
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860-651-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.70
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.87
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.13
|
|
|
Service Code
|
NDC 0409-9558-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna American Axle |
$16.98
|
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.98
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.90
|
| Rate for Payer: Healthscope Commercial |
$23.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.21
|
| Rate for Payer: PHP Commercial |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.29
|
| Rate for Payer: Priority Health SBD |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15.14
|
|
|
Service Code
|
NDC 71839-141-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$13.63 |
| Rate for Payer: Aetna American Axle |
$9.84
|
| Rate for Payer: Aetna Commercial |
$12.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.84
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cofinity Commercial |
$10.60
|
| Rate for Payer: Cofinity Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.11
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.87
|
| Rate for Payer: PHP Commercial |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$6.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.36
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
NDC 63323-426-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna American Axle |
$25.57
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Commercial |
$27.54
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.44
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.54
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: UMR Bronson Commercial |
$17.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.57
|
|
|
Service Code
|
NDC 67457-228-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.57
|
|
|
Service Code
|
NDC 67457-228-99
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.00
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860-651-42
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.42
|
| Rate for Payer: Healthscope Commercial |
$40.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.70
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.87
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.39
|
|
|
Service Code
|
NDC 43547-531-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.03
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.67
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 0143-9251-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Aetna American Axle |
$18.83
|
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.83
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$24.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$26.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: PHP Commercial |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: Priority Health SBD |
$18.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.73
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.18
|
|
|
Service Code
|
NDC 55150-225-05
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$23.56 |
| Rate for Payer: Aetna American Axle |
$17.02
|
| Rate for Payer: Aetna Commercial |
$22.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.02
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$23.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.25
|
| Rate for Payer: PHP Commercial |
$22.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.33
|
| Rate for Payer: Priority Health SBD |
$16.49
|
| Rate for Payer: UMR Bronson Commercial |
$11.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.64
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
NDC 72611-757-01
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Aetna American Axle |
$19.32
|
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.32
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$26.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.27
|
| Rate for Payer: PHP Commercial |
$25.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.81
|
| Rate for Payer: Priority Health SBD |
$18.73
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.30
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.79
|
|
|
Service Code
|
NDC 39822-4200-6
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.03 |
| Max. Negotiated Rate |
$20.51 |
| Rate for Payer: Aetna American Axle |
$14.81
|
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.81
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$19.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.23
|
| Rate for Payer: Healthscope Commercial |
$20.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.37
|
| Rate for Payer: PHP Commercial |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.95
|
| Rate for Payer: Priority Health SBD |
$14.36
|
| Rate for Payer: UMR Bronson Commercial |
$10.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.09
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-3189-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna American Axle |
$15.27
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.13
|
|
|
Service Code
|
NDC 0409-9558-31
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna American Axle |
$16.98
|
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.98
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.90
|
| Rate for Payer: Healthscope Commercial |
$23.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.21
|
| Rate for Payer: PHP Commercial |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.29
|
| Rate for Payer: Priority Health SBD |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
NDC 72611-757-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$26.76 |
| Rate for Payer: Aetna American Axle |
$19.32
|
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.32
|
| Rate for Payer: Cash Price |
$23.78
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$26.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.27
|
| Rate for Payer: PHP Commercial |
$25.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.81
|
| Rate for Payer: Priority Health SBD |
$18.73
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.30
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.17
|
|
|
Service Code
|
NDC 72572-651-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.75 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna American Axle |
$14.41
|
| Rate for Payer: Aetna Commercial |
$18.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.41
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$19.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.84
|
| Rate for Payer: PHP Commercial |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health SBD |
$13.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.63
|
|
