|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.87
|
|
|
Service Code
|
NDC 00143925101
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna American Axle |
$14.87
|
| Rate for Payer: Aetna Commercial |
$19.44
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.87
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cofinity Advantage |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$20.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.15
|
| Rate for Payer: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.87
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Exchange |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$19.90
|
|
|
Service Code
|
NDC 25021066210
|
| 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 |
$16.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cofinity Advantage |
$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 |
$14.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.93
|
| Rate for Payer: PHP Commercial |
$16.91
|
| 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 |
$14.93
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.79
|
|
|
Service Code
|
NDC 39822420006
|
| 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 Advantage |
$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 Commercial |
$19.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.09
|
| Rate for Payer: PHP Commercial |
$19.37
|
| 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
|
OP
|
$19.90
|
|
|
Service Code
|
NDC 25021066210
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Aetna American Axle |
$12.94
|
| Rate for Payer: Aetna Commercial |
$16.91
|
| Rate for Payer: Aetna Medicare |
$9.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.94
|
| Rate for Payer: BCBS Complete |
$7.96
|
| Rate for Payer: Cash Price |
$15.92
|
| Rate for Payer: Cofinity Advantage |
$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 |
$14.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.93
|
| Rate for Payer: PHP Commercial |
$16.91
|
| Rate for Payer: Priority Health SBD |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.94
|
| Rate for Payer: UHC Core |
$10.37
|
| Rate for Payer: UHC Exchange |
$7.82
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860065110
|
| 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 Advantage |
$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 Commercial |
$38.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.15
|
| Rate for Payer: PHP Commercial |
$38.70
|
| 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
|
$22.87
|
|
|
Service Code
|
NDC 00143925110
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna American Axle |
$14.87
|
| Rate for Payer: Aetna Commercial |
$19.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.87
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cofinity Advantage |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$20.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.15
|
| Rate for Payer: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.87
|
|
|
Service Code
|
NDC 00143925110
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna American Axle |
$14.87
|
| Rate for Payer: Aetna Commercial |
$19.44
|
| Rate for Payer: Aetna Medicare |
$11.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.87
|
| Rate for Payer: BCBS Complete |
$9.15
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cofinity Advantage |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$20.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.15
|
| Rate for Payer: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.87
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Exchange |
$8.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$45.53
|
|
|
Service Code
|
NDC 70860065110
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$22.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: BCBS Complete |
$18.21
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$36.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.15
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.59
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: UHC Exchange |
$17.89
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$31.51
|
|
|
Service Code
|
NDC 00409955810
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.86 |
| Max. Negotiated Rate |
$28.36 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: Cash Price |
$25.21
|
| Rate for Payer: Cofinity Advantage |
$22.06
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.21
|
| Rate for Payer: Healthscope Commercial |
$28.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.63
|
| Rate for Payer: PHP Commercial |
$26.78
|
| Rate for Payer: Priority Health SBD |
$19.85
|
| Rate for Payer: UMR Bronson Commercial |
$13.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.63
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$45.53
|
|
|
Service Code
|
NDC 70860065142
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$40.98 |
| Rate for Payer: Aetna American Axle |
$29.59
|
| Rate for Payer: Aetna Commercial |
$38.70
|
| Rate for Payer: Aetna Medicare |
$22.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.59
|
| Rate for Payer: BCBS Complete |
$18.21
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$36.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.15
|
| Rate for Payer: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.59
|
| Rate for Payer: UHC Core |
$23.72
|
| Rate for Payer: UHC Exchange |
$17.89
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$31.51
|
|
|
Service Code
|
NDC 00409955810
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$28.36 |
| Rate for Payer: Aetna American Axle |
$20.48
|
| Rate for Payer: Aetna Commercial |
$26.78
|
| Rate for Payer: Aetna Medicare |
$15.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.48
|
| Rate for Payer: BCBS Complete |
$12.60
|
| Rate for Payer: Cash Price |
$25.21
|
| Rate for Payer: Cofinity Advantage |
$22.06
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.21
|
| Rate for Payer: Healthscope Commercial |
$28.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.63
|
| Rate for Payer: PHP Commercial |
$26.78
|
| Rate for Payer: Priority Health SBD |
$19.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Core |
$16.42
|
| Rate for Payer: UHC Exchange |
$12.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.63
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
NDC 63323042610
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$35.41 |
| Rate for Payer: Aetna American Axle |
$25.57
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$20.50
|
| Rate for Payer: UHC Exchange |
$15.46
|
| Rate for Payer: UMR Bronson Commercial |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.87
|
|
|
Service Code
|
NDC 00143925101
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna American Axle |
$14.87
|
| Rate for Payer: Aetna Commercial |
$19.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.87
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cofinity Advantage |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$20.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.15
|
| Rate for Payer: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$10.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.15
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.79
|
|
|
Service Code
|
NDC 39822420006
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$20.51 |
| Rate for Payer: Aetna American Axle |
$14.81
|
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.81
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$18.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.09
|
| Rate for Payer: PHP Commercial |
$19.37
|
| Rate for Payer: Priority Health SBD |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.81
|
| Rate for Payer: UHC Core |
$11.87
|
| Rate for Payer: UHC Exchange |
$8.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.09
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
NDC 63323042610
|
| 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 Advantage |
$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 Commercial |
$33.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: PHP Commercial |
$33.44
|
| 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
|
$45.53
|
|
|
Service Code
|
NDC 70860065142
|
| 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 Advantage |
$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 Commercial |
$38.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.15
|
| Rate for Payer: PHP Commercial |
$38.70
|
| 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
|
OP
|
$1,528.81
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$565.66 |
| Max. Negotiated Rate |
$1,375.93 |
| Rate for Payer: Aetna American Axle |
$993.73
|
| Rate for Payer: Aetna Commercial |
$1,299.49
|
| Rate for Payer: Aetna Medicare |
$764.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.73
|
| Rate for Payer: BCBS Complete |
$611.52
|
| Rate for Payer: Cash Price |
$1,223.05
|
| Rate for Payer: Cofinity Advantage |
$1,070.17
|
| Rate for Payer: Cofinity Commercial |
$1,314.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.05
|
| Rate for Payer: Healthscope Commercial |
$1,375.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,070.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,146.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,223.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.61
|
| Rate for Payer: PHP Commercial |
$1,299.49
|
| Rate for Payer: Priority Health SBD |
$963.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.73
|
| Rate for Payer: UHC Core |
$796.51
|
| Rate for Payer: UHC Exchange |
$600.82
|
| Rate for Payer: UMR Bronson Commercial |
$565.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,146.61
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$1,528.81
|
|
|
Service Code
|
NDC 00310009530
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$672.68 |
| Max. Negotiated Rate |
$1,375.93 |
| Rate for Payer: Aetna American Axle |
$993.73
|
| Rate for Payer: Aetna Commercial |
$1,299.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.73
|
| Rate for Payer: Cash Price |
$1,223.05
|
| Rate for Payer: Cofinity Advantage |
$1,070.17
|
| Rate for Payer: Cofinity Commercial |
$1,314.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,223.05
|
| Rate for Payer: Healthscope Commercial |
$1,375.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,070.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,146.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,299.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,146.61
|
| Rate for Payer: PHP Commercial |
$1,299.49
|
| Rate for Payer: Priority Health SBD |
$963.15
|
| Rate for Payer: UMR Bronson Commercial |
$672.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,146.61
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
IP
|
$75.32
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$67.79 |
| Rate for Payer: Aetna American Axle |
$48.96
|
| Rate for Payer: Aetna Commercial |
$64.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.96
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Advantage |
$52.72
|
| Rate for Payer: Cofinity Commercial |
$64.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Healthscope Commercial |
$67.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.49
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: Priority Health SBD |
$47.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.49
|
|
|
ROFLUMILAST 500 MCG TABLET
|
Facility
|
OP
|
$75.32
|
|
|
Service Code
|
NDC 72205020030
|
| Hospital Charge Code |
152640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$67.79 |
| Rate for Payer: Aetna American Axle |
$48.96
|
| Rate for Payer: Aetna Commercial |
$64.02
|
| Rate for Payer: Aetna Medicare |
$37.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.96
|
| Rate for Payer: BCBS Complete |
$30.13
|
| Rate for Payer: Cash Price |
$60.26
|
| Rate for Payer: Cofinity Advantage |
$52.72
|
| Rate for Payer: Cofinity Commercial |
$64.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.26
|
| Rate for Payer: Healthscope Commercial |
$67.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.49
|
| Rate for Payer: PHP Commercial |
$64.02
|
| Rate for Payer: Priority Health SBD |
$47.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.96
|
| Rate for Payer: UHC Core |
$39.24
|
| Rate for Payer: UHC Exchange |
$29.60
|
| Rate for Payer: UMR Bronson Commercial |
$27.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.49
|
|
|
ROMIPLOSTIM 125 MCG/1 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
OP
|
$5,960.78
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
301226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,205.49 |
| Max. Negotiated Rate |
$5,364.70 |
| Rate for Payer: Aetna American Axle |
$3,874.51
|
| Rate for Payer: Aetna Commercial |
$5,066.66
|
| Rate for Payer: Aetna Medicare |
$2,980.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,874.51
|
| Rate for Payer: BCBS Complete |
$2,384.31
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cofinity Advantage |
$4,172.55
|
| Rate for Payer: Cofinity Commercial |
$5,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,768.62
|
| Rate for Payer: Healthscope Commercial |
$5,364.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,172.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,470.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,768.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,066.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,470.59
|
| Rate for Payer: PHP Commercial |
$5,066.66
|
| Rate for Payer: Priority Health SBD |
$3,755.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,980.39
|
| Rate for Payer: UHC Core |
$2,980.39
|
| Rate for Payer: UHC Exchange |
$2,980.39
|
| Rate for Payer: UMR Bronson Commercial |
$2,205.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,470.59
|
|
|
ROMIPLOSTIM 125 MCG/1 ML SUBCUTANEOUS SOLUTION (CUSTOM)
|
Facility
|
IP
|
$5,960.78
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
301226
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,622.74 |
| Max. Negotiated Rate |
$5,364.70 |
| Rate for Payer: Aetna American Axle |
$3,874.51
|
| Rate for Payer: Aetna Commercial |
$5,066.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,874.51
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cofinity Advantage |
$4,172.55
|
| Rate for Payer: Cofinity Commercial |
$5,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,768.62
|
| Rate for Payer: Healthscope Commercial |
$5,364.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,172.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,470.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,066.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,470.59
|
| Rate for Payer: PHP Commercial |
$5,066.66
|
| Rate for Payer: Priority Health SBD |
$3,755.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,622.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,470.59
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$5,960.78
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$5,364.70 |
| Rate for Payer: Aetna American Axle |
$3,874.51
|
| Rate for Payer: Aetna Commercial |
$5,066.66
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,874.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$35.80
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cofinity Advantage |
$4,172.55
|
| Rate for Payer: Cofinity Commercial |
$5,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,768.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$5,364.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,172.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,470.59
|
| Rate for Payer: Mclaren Medicaid |
$11.11
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,066.66
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,470.59
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$5,066.66
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$3,755.29
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,205.49
|
| Rate for Payer: VA VA |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,470.59
|
|
|
ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$5,960.78
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
192147
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,622.74 |
| Max. Negotiated Rate |
$5,364.70 |
| Rate for Payer: Aetna American Axle |
$3,874.51
|
| Rate for Payer: Aetna Commercial |
$5,066.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,874.51
|
| Rate for Payer: Cash Price |
$4,768.62
|
| Rate for Payer: Cofinity Advantage |
$4,172.55
|
| Rate for Payer: Cofinity Commercial |
$5,126.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,768.62
|
| Rate for Payer: Healthscope Commercial |
$5,364.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,172.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,470.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,066.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,470.59
|
| Rate for Payer: PHP Commercial |
$5,066.66
|
| Rate for Payer: Priority Health SBD |
$3,755.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,622.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,470.59
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$11,921.56
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.81 |
| Max. Negotiated Rate |
$10,729.40 |
| Rate for Payer: Aetna American Axle |
$7,749.01
|
| Rate for Payer: Aetna Commercial |
$10,133.33
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,749.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.89
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS MAPPO |
$11.11
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$35.80
|
| Rate for Payer: BCN Medicare Advantage |
$11.11
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cash Price |
$9,537.25
|
| Rate for Payer: Cofinity Advantage |
$8,345.09
|
| Rate for Payer: Cofinity Commercial |
$10,252.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9,537.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.11
|
| Rate for Payer: Healthscope Commercial |
$10,729.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8,345.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8,941.17
|
| Rate for Payer: Mclaren Medicaid |
$11.11
|
| Rate for Payer: Mclaren Medicare |
$11.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.67
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,133.33
|
| Rate for Payer: Nomi Health Commercial |
$33.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8,941.17
|
| Rate for Payer: PACE Medicare |
$10.55
|
| Rate for Payer: PACE SWMI |
$11.11
|
| Rate for Payer: PHP Commercial |
$10,133.33
|
| Rate for Payer: PHP Medicare Advantage |
$11.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34.74
|
| Rate for Payer: Priority Health Medicare |
$11.11
|
| Rate for Payer: Priority Health SBD |
$7,510.58
|
| Rate for Payer: Priority Health Tiered Network |
$27.79
|
| Rate for Payer: Railroad Medicare Medicare |
$11.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.23
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.11
|
| Rate for Payer: UHC Exchange |
$18.23
|
| Rate for Payer: UHC Medicaid |
$5.81
|
| Rate for Payer: UHCCP Medicaid |
$5.81
|
| Rate for Payer: UMR Bronson Commercial |
$4,410.98
|
| Rate for Payer: VA VA |
$11.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8,941.17
|
|
