|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
IP
|
$121.05
|
|
|
Service Code
|
NDC 23155024546
|
| 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 |
$84.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.73
|
| 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 |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.89
|
| Rate for Payer: PHP Commercial |
$102.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.68
|
| 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 23155024522
|
| 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: Cofinity Medicare Advantage |
$4.71
|
| 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 Commercial |
$5.72
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| 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
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
OP
|
$121.05
|
|
|
Service Code
|
NDC 23155024546
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.79 |
| Max. Negotiated Rate |
$108.94 |
| Rate for Payer: Aetna American Axle |
$78.68
|
| Rate for Payer: Aetna Commercial |
$102.89
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.68
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: Cash Price |
$96.84
|
| Rate for Payer: Cofinity Commercial |
$104.10
|
| Rate for Payer: Cofinity Commercial |
$84.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.73
|
| 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 |
$84.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.89
|
| Rate for Payer: PHP Commercial |
$102.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.68
|
| Rate for Payer: Priority Health SBD |
$76.26
|
| Rate for Payer: UMR Bronson Commercial |
$44.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.79
|
|
|
RIZATRIPTAN 10 MG TABLET
|
Facility
|
OP
|
$6.73
|
|
|
Service Code
|
NDC 23155024522
|
| Hospital Charge Code |
23377
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna American Axle |
$4.37
|
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: BCBS Complete |
$2.69
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Commercial |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.71
|
| 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 Commercial |
$5.72
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.37
|
| Rate for Payer: Priority Health SBD |
$4.24
|
| Rate for Payer: UMR Bronson Commercial |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.79
|
|
|
Service Code
|
NDC 39822420005
|
| 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: Cofinity Medicare Advantage |
$15.95
|
| 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: PHP Commercial |
$19.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| 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
|
$24.66
|
|
|
Service Code
|
NDC 00781322092
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna American Axle |
$16.03
|
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.03
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$21.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.73
|
| Rate for Payer: Healthscope Commercial |
$22.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.96
|
| Rate for Payer: PHP Commercial |
$20.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.03
|
| Rate for Payer: Priority Health SBD |
$15.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.87
|
|
|
Service Code
|
NDC 00409955831
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna American Axle |
$20.72
|
| Rate for Payer: Aetna Commercial |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Commercial |
$27.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$28.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.09
|
| Rate for Payer: PHP Commercial |
$27.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health SBD |
$20.08
|
| Rate for Payer: UMR Bronson Commercial |
$14.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.90
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.87
|
|
|
Service Code
|
NDC 00409955831
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna American Axle |
$20.72
|
| Rate for Payer: Aetna Commercial |
$27.09
|
| Rate for Payer: Aetna Medicare |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.72
|
| Rate for Payer: BCBS Complete |
$12.75
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Commercial |
$27.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$28.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.09
|
| Rate for Payer: PHP Commercial |
$27.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health SBD |
$20.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.90
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
NDC 71839014201
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.83
|
|
|
Service Code
|
NDC 71839014110
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Medicare |
$13.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.83
|
|
|
Service Code
|
NDC 71839014110
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$24.15 |
| Rate for Payer: Aetna American Axle |
$17.44
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Commercial |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.49
|
|
|
Service Code
|
NDC 00409318905
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna American Axle |
$15.27
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.44
|
| 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 Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.53
|
|
|
Service Code
|
NDC 70860065142
|
| 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: Cofinity Medicare Advantage |
$31.87
|
| 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: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.59
|
| 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
|
OP
|
$45.53
|
|
|
Service Code
|
NDC 70860065110
|
| Hospital Charge Code |
12734
|
|
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 Commercial |
$31.87
|
| Rate for Payer: Cofinity Commercial |
$39.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.87
|
| 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: PHP Commercial |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.59
|
| Rate for Payer: Priority Health SBD |
$28.68
|
| Rate for Payer: UMR Bronson Commercial |
$16.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$31.87
|
|
|
Service Code
|
NDC 00409955810
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna American Axle |
$20.72
|
| Rate for Payer: Aetna Commercial |
$27.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.72
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Commercial |
$27.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$28.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.09
|
| Rate for Payer: PHP Commercial |
$27.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health SBD |
$20.08
|
| Rate for Payer: UMR Bronson Commercial |
$14.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.90
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$31.87
|
|
|
Service Code
|
NDC 00409955810
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna American Axle |
$20.72
|
| Rate for Payer: Aetna Commercial |
$27.09
|
| Rate for Payer: Aetna Medicare |
$15.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.72
|
| Rate for Payer: BCBS Complete |
$12.75
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Cofinity Commercial |
$27.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.50
|
| Rate for Payer: Healthscope Commercial |
$28.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.09
|
| Rate for Payer: PHP Commercial |
$27.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health SBD |
$20.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.90
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.72
|
|
|
Service Code
|
NDC 55150022610
|
| 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: Cofinity Medicare Advantage |
$18.70
|
| 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 Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| 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
|
OP
|
$26.72
|
|
|
Service Code
|
NDC 55150022610
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna American Axle |
$17.37
|
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$13.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.37
|
| Rate for Payer: BCBS Complete |
$10.69
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.70
|
| 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 Commercial |
$22.71
|
| Rate for Payer: PHP Commercial |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: Priority Health SBD |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$9.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.04
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$29.60
|
|
|
Service Code
|
NDC 70748034902
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Medicare |
$14.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: BCBS Complete |
$11.84
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.34
|
|
|
Service Code
|
NDC 63323042601
|
| 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: Cofinity Medicare Advantage |
$27.54
|
| 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: PHP Commercial |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.57
|
| 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
|
$29.60
|
|
|
Service Code
|
NDC 70748034902
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
NDC 71839014210
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
NDC 71839014210
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.60
|
|
|
Service Code
|
NDC 70748034901
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.02 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna American Axle |
$19.24
|
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.16
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.24
|
| Rate for Payer: Priority Health SBD |
$18.65
|
| Rate for Payer: UMR Bronson Commercial |
$13.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.17
|
|
|
Service Code
|
NDC 72572065101
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna American Axle |
$14.41
|
| Rate for Payer: Aetna Commercial |
$18.84
|
| Rate for Payer: Aetna Medicare |
$11.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.41
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.52
|
| 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 Commercial |
$18.84
|
| Rate for Payer: PHP Commercial |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health SBD |
$13.97
|
| Rate for Payer: UMR Bronson Commercial |
$8.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.63
|
|
