|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 0143-9251-01
|
| 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
|
$39.34
|
|
|
Service Code
|
NDC 63323-426-10
|
| 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
|
$19.90
|
|
|
Service Code
|
NDC 25021-662-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$17.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.92
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.39
|
|
|
Service Code
|
NDC 43547-531-10
|
| 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
|
$19.45
|
|
|
Service Code
|
NDC 66794-229-41
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna American Axle |
$12.64
|
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.64
|
| Rate for Payer: Cash Price |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.53
|
| Rate for Payer: PHP Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.59
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.45
|
|
|
Service Code
|
NDC 66794-229-02
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna American Axle |
$12.64
|
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.64
|
| Rate for Payer: Cash Price |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$13.62
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.53
|
| Rate for Payer: PHP Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.59
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.65
|
|
|
Service Code
|
NDC 43066-013-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$16.78 |
| Rate for Payer: Aetna American Axle |
$12.12
|
| Rate for Payer: Aetna Commercial |
$15.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.12
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$16.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Healthscope Commercial |
$16.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.85
|
| Rate for Payer: PHP Commercial |
$15.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.06
|
| Rate for Payer: Priority Health SBD |
$11.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.99
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.13
|
|
|
Service Code
|
NDC 0409-9558-50
|
| 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
|
$22.79
|
|
|
Service Code
|
NDC 39822-4200-5
|
| 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 IV (CODE)
|
Facility
|
IP
|
$19.90
|
|
|
Service Code
|
NDC 25021-662-10
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.76 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$17.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.93
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.92
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
NDC 63323-426-10
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$22.79
|
|
|
Service Code
|
NDC 39822-4200-6
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860-651-10
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 0143-9251-10
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$26.13
|
|
|
Service Code
|
NDC 0409-9558-10
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 0143-9251-01
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860-651-42
|
| Hospital Charge Code |
163721
|
|
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
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,374.52
|
|
|
Service Code
|
NDC 0310-0095-30
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$604.79 |
| Max. Negotiated Rate |
$1,237.07 |
| Rate for Payer: Aetna American Axle |
$893.44
|
| Rate for Payer: Aetna Commercial |
$1,168.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.44
|
| Rate for Payer: Cash Price |
$1,099.62
|
| Rate for Payer: Cofinity Commercial |
$1,182.09
|
| Rate for Payer: Cofinity Commercial |
$962.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,099.62
|
| Rate for Payer: Healthscope Commercial |
$1,237.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$962.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,030.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,168.34
|
| Rate for Payer: PHP Commercial |
$1,168.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$962.16
|
| Rate for Payer: Priority Health SBD |
$865.95
|
| Rate for Payer: UMR Bronson Commercial |
$604.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,030.89
|
|
|
ROMIPLOSTIM 125 MCG/1 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
IP
|
$4,006.40
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
301226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,762.82 |
| Max. Negotiated Rate |
$3,605.76 |
| Rate for Payer: Aetna American Axle |
$2,604.16
|
| Rate for Payer: Aetna Commercial |
$3,405.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,604.16
|
| Rate for Payer: Cash Price |
$3,205.12
|
| Rate for Payer: Cofinity Commercial |
$2,804.48
|
| Rate for Payer: Cofinity Commercial |
$3,445.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,205.12
|
| Rate for Payer: Healthscope Commercial |
$3,605.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,405.44
|
| Rate for Payer: PHP Commercial |
$3,405.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,804.48
|
| Rate for Payer: Priority Health SBD |
$2,524.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,762.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.80
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$4,006.40
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$3,605.76 |
| Rate for Payer: Aetna American Axle |
$2,604.16
|
| Rate for Payer: Aetna Commercial |
$3,405.44
|
| Rate for Payer: Aetna Medicare |
$99.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,604.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.03
|
| Rate for Payer: BCBS Complete |
$55.16
|
| Rate for Payer: BCBS MAPPO |
$96.03
|
| Rate for Payer: BCBS Trust/PPO |
$310.29
|
| Rate for Payer: BCN Medicare Advantage |
$96.03
|
| Rate for Payer: Cash Price |
$3,205.12
|
| Rate for Payer: Cash Price |
$3,205.12
|
| Rate for Payer: Cofinity Commercial |
$3,445.50
|
| Rate for Payer: Cofinity Commercial |
$2,804.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,205.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.03
|
| Rate for Payer: Healthscope Commercial |
$3,605.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.80
|
| Rate for Payer: Mclaren Medicaid |
$52.53
|
| Rate for Payer: Mclaren Medicare |
$96.03
|
| Rate for Payer: Meridian Medicaid |
$55.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,405.44
|
| Rate for Payer: PACE Medicare |
$91.23
|
| Rate for Payer: PACE SWMI |
$96.03
|
| Rate for Payer: PHP Commercial |
$3,405.44
|
| Rate for Payer: PHP Medicare Advantage |
$96.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,804.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.22
|
| Rate for Payer: Priority Health Medicare |
$96.03
|
| Rate for Payer: Priority Health Narrow Network |
$224.98
|
| Rate for Payer: Priority Health SBD |
$2,524.03
|
| Rate for Payer: Railroad Medicare Medicare |
$96.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.03
|
| Rate for Payer: UHC Medicare Advantage |
$98.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,482.37
|
| Rate for Payer: VA VA |
$96.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.80
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$4,006.40
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,762.82 |
| Max. Negotiated Rate |
$3,605.76 |
| Rate for Payer: Aetna American Axle |
$2,604.16
|
| Rate for Payer: Aetna Commercial |
$3,405.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,604.16
|
| Rate for Payer: Cash Price |
$3,205.12
|
| Rate for Payer: Cofinity Commercial |
$2,804.48
|
| Rate for Payer: Cofinity Commercial |
$3,445.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,205.12
|
| Rate for Payer: Healthscope Commercial |
$3,605.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,804.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,004.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,405.44
|
| Rate for Payer: PHP Commercial |
$3,405.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,804.48
|
| Rate for Payer: Priority Health SBD |
$2,524.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,762.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,004.80
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$11,242.83
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$10,118.55 |
| Rate for Payer: Aetna American Axle |
$7,307.84
|
| Rate for Payer: Aetna Commercial |
$9,556.41
|
| Rate for Payer: Aetna Medicare |
$99.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,307.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.03
|
| Rate for Payer: BCBS Complete |
$55.16
|
| Rate for Payer: BCBS MAPPO |
$96.03
|
| Rate for Payer: BCBS Trust/PPO |
$310.29
|
| Rate for Payer: BCN Medicare Advantage |
$96.03
|
| Rate for Payer: Cash Price |
$8,994.26
|
| Rate for Payer: Cash Price |
$8,994.26
|
| Rate for Payer: Cofinity Commercial |
$9,668.83
|
| Rate for Payer: Cofinity Commercial |
$7,869.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.03
|
| Rate for Payer: Healthscope Commercial |
$10,118.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,869.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,432.12
|
| Rate for Payer: Mclaren Medicaid |
$52.53
|
| Rate for Payer: Mclaren Medicare |
$96.03
|
| Rate for Payer: Meridian Medicaid |
$55.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,556.41
|
| Rate for Payer: PACE Medicare |
$91.23
|
| Rate for Payer: PACE SWMI |
$96.03
|
| Rate for Payer: PHP Commercial |
$9,556.41
|
| Rate for Payer: PHP Medicare Advantage |
$96.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,869.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.22
|
| Rate for Payer: Priority Health Medicare |
$96.03
|
| Rate for Payer: Priority Health Narrow Network |
$224.98
|
| Rate for Payer: Priority Health SBD |
$7,082.98
|
| Rate for Payer: Railroad Medicare Medicare |
$96.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.03
|
| Rate for Payer: UHC Medicare Advantage |
$98.91
|
| Rate for Payer: UMR Bronson Commercial |
$4,159.85
|
| Rate for Payer: VA VA |
$96.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,432.12
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$11,242.83
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,946.85 |
| Max. Negotiated Rate |
$10,118.55 |
| Rate for Payer: Aetna American Axle |
$7,307.84
|
| Rate for Payer: Aetna Commercial |
$9,556.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,307.84
|
| Rate for Payer: Cash Price |
$8,994.26
|
| Rate for Payer: Cofinity Commercial |
$7,869.98
|
| Rate for Payer: Cofinity Commercial |
$9,668.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,994.26
|
| Rate for Payer: Healthscope Commercial |
$10,118.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7,869.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,432.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,556.41
|
| Rate for Payer: PHP Commercial |
$9,556.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,869.98
|
| Rate for Payer: Priority Health SBD |
$7,082.98
|
| Rate for Payer: UMR Bronson Commercial |
$4,946.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,432.12
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$13,020.62
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$11,718.56 |
| Rate for Payer: Aetna American Axle |
$8,463.40
|
| Rate for Payer: Aetna Commercial |
$11,067.53
|
| Rate for Payer: Aetna Medicare |
$99.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,463.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.03
|
| Rate for Payer: BCBS Complete |
$55.16
|
| Rate for Payer: BCBS MAPPO |
$96.03
|
| Rate for Payer: BCBS Trust/PPO |
$310.29
|
| Rate for Payer: BCN Medicare Advantage |
$96.03
|
| Rate for Payer: Cash Price |
$10,416.50
|
| Rate for Payer: Cash Price |
$10,416.50
|
| Rate for Payer: Cofinity Commercial |
$9,114.43
|
| Rate for Payer: Cofinity Commercial |
$11,197.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,416.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.03
|
| Rate for Payer: Healthscope Commercial |
$11,718.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,114.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,765.46
|
| Rate for Payer: Mclaren Medicaid |
$52.53
|
| Rate for Payer: Mclaren Medicare |
$96.03
|
| Rate for Payer: Meridian Medicaid |
$55.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,067.53
|
| Rate for Payer: PACE Medicare |
$91.23
|
| Rate for Payer: PACE SWMI |
$96.03
|
| Rate for Payer: PHP Commercial |
$11,067.53
|
| Rate for Payer: PHP Medicare Advantage |
$96.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,114.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.22
|
| Rate for Payer: Priority Health Medicare |
$96.03
|
| Rate for Payer: Priority Health Narrow Network |
$224.98
|
| Rate for Payer: Priority Health SBD |
$8,202.99
|
| Rate for Payer: Railroad Medicare Medicare |
$96.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.03
|
| Rate for Payer: UHC Medicare Advantage |
$98.91
|
| Rate for Payer: UMR Bronson Commercial |
$4,817.63
|
| Rate for Payer: VA VA |
$96.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,765.46
|
|
|
ROMIPLOSTIM 500 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$13,020.62
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,729.07 |
| Max. Negotiated Rate |
$11,718.56 |
| Rate for Payer: Aetna American Axle |
$8,463.40
|
| Rate for Payer: Aetna Commercial |
$11,067.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,463.40
|
| Rate for Payer: Cash Price |
$10,416.50
|
| Rate for Payer: Cofinity Commercial |
$11,197.73
|
| Rate for Payer: Cofinity Commercial |
$9,114.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,416.50
|
| Rate for Payer: Healthscope Commercial |
$11,718.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,114.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,765.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,067.53
|
| Rate for Payer: PHP Commercial |
$11,067.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,114.43
|
| Rate for Payer: Priority Health SBD |
$8,202.99
|
| Rate for Payer: UMR Bronson Commercial |
$5,729.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,765.46
|
|
