|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
IP
|
$175.56
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna American Axle |
$114.11
|
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.11
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Commercial |
$122.89
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.11
|
| Rate for Payer: Priority Health SBD |
$110.60
|
| Rate for Payer: UMR Bronson Commercial |
$77.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.67
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$175.56
|
|
|
Service Code
|
NDC 65862064960
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna American Axle |
$114.11
|
| Rate for Payer: Aetna Commercial |
$149.23
|
| Rate for Payer: Aetna Medicare |
$87.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.11
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: Cash Price |
$140.45
|
| Rate for Payer: Cofinity Commercial |
$122.89
|
| Rate for Payer: Cofinity Commercial |
$150.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.45
|
| Rate for Payer: Healthscope Commercial |
$158.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.23
|
| Rate for Payer: PHP Commercial |
$149.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.11
|
| Rate for Payer: Priority Health SBD |
$110.60
|
| Rate for Payer: UMR Bronson Commercial |
$64.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.67
|
|
|
RIVASTIGMINE 3 MG CAPSULE
|
Facility
|
OP
|
$156.39
|
|
|
Service Code
|
NDC 62756014686
|
| Hospital Charge Code |
28279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.86 |
| Max. Negotiated Rate |
$140.75 |
| Rate for Payer: Aetna American Axle |
$101.65
|
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$78.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.65
|
| Rate for Payer: BCBS Complete |
$62.56
|
| Rate for Payer: Cash Price |
$125.11
|
| Rate for Payer: Cofinity Commercial |
$109.47
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$109.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.11
|
| Rate for Payer: Healthscope Commercial |
$140.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$109.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.93
|
| Rate for Payer: PHP Commercial |
$132.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.65
|
| Rate for Payer: Priority Health SBD |
$98.53
|
| Rate for Payer: UMR Bronson Commercial |
$57.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.29
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$78.69
|
|
|
Service Code
|
NDC 00078050161
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna American Axle |
$51.15
|
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna Medicare |
$39.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: BCBS Complete |
$31.48
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.95
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.15
|
| Rate for Payer: Priority Health SBD |
$49.57
|
| Rate for Payer: UMR Bronson Commercial |
$29.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,360.53
|
|
|
Service Code
|
NDC 00078050115
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,038.63 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna American Axle |
$1,534.34
|
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.34
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$1,652.37
|
| Rate for Payer: Cofinity Commercial |
$2,030.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,652.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.42
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,652.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.34
|
| Rate for Payer: Priority Health SBD |
$1,487.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,038.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.69
|
|
|
Service Code
|
NDC 00078050161
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna American Axle |
$51.15
|
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.95
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.15
|
| Rate for Payer: Priority Health SBD |
$49.57
|
| Rate for Payer: UMR Bronson Commercial |
$34.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$2,360.53
|
|
|
Service Code
|
NDC 00078050115
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$873.40 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna American Axle |
$1,534.34
|
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna Medicare |
$1,180.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.34
|
| Rate for Payer: BCBS Complete |
$944.21
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$1,652.37
|
| Rate for Payer: Cofinity Commercial |
$2,030.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,652.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.42
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,652.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.34
|
| Rate for Payer: Priority Health SBD |
$1,487.13
|
| Rate for Payer: UMR Bronson Commercial |
$873.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$2,360.53
|
|
|
Service Code
|
NDC 00078050215
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,038.63 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna American Axle |
$1,534.34
|
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.34
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$1,652.37
|
| Rate for Payer: Cofinity Commercial |
$2,030.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,652.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.42
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,652.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.34
|
| Rate for Payer: Priority Health SBD |
$1,487.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,038.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
IP
|
$78.69
|
|
|
Service Code
|
NDC 00078050261
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.62 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna American Axle |
$51.15
|
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.95
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.15
|
| Rate for Payer: Priority Health SBD |
$49.57
|
| Rate for Payer: UMR Bronson Commercial |
$34.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$78.69
|
|
|
Service Code
|
NDC 00078050261
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$70.82 |
| Rate for Payer: Aetna American Axle |
$51.15
|
| Rate for Payer: Aetna Commercial |
$66.89
|
| Rate for Payer: Aetna Medicare |
$39.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: BCBS Complete |
$31.48
|
| Rate for Payer: Cash Price |
$62.95
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.95
|
| Rate for Payer: Healthscope Commercial |
$70.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.89
|
| Rate for Payer: PHP Commercial |
$66.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.15
|
| Rate for Payer: Priority Health SBD |
$49.57
|
| Rate for Payer: UMR Bronson Commercial |
$29.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.02
|
|
|
RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH
|
Facility
|
OP
|
$2,360.53
|
|
|
Service Code
|
NDC 00078050215
|
| Hospital Charge Code |
82505
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$873.40 |
| Max. Negotiated Rate |
$2,124.48 |
| Rate for Payer: Aetna American Axle |
$1,534.34
|
| Rate for Payer: Aetna Commercial |
$2,006.45
|
| Rate for Payer: Aetna Medicare |
$1,180.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.34
|
| Rate for Payer: BCBS Complete |
$944.21
|
| Rate for Payer: Cash Price |
$1,888.42
|
| Rate for Payer: Cofinity Commercial |
$1,652.37
|
| Rate for Payer: Cofinity Commercial |
$2,030.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,652.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,888.42
|
| Rate for Payer: Healthscope Commercial |
$2,124.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,652.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,006.45
|
| Rate for Payer: PHP Commercial |
$2,006.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.34
|
| Rate for Payer: Priority Health SBD |
$1,487.13
|
| Rate for Payer: UMR Bronson Commercial |
$873.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,770.40
|
|
|
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 |
$84.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.84
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
$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 |
$3.36
|
| 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
|
|
|
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 |
$84.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.84
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.79
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.01
|
|
|
Service Code
|
NDC 43547053110
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.11 |
| Rate for Payer: Aetna American Axle |
$12.36
|
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: Cash Price |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.21
|
| Rate for Payer: Healthscope Commercial |
$17.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.16
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.36
|
| Rate for Payer: Priority Health SBD |
$11.98
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.26
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.13
|
|
|
Service Code
|
NDC 00409703701
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: Aetna American Axle |
$16.98
|
| Rate for Payer: Aetna Commercial |
$22.21
|
| Rate for Payer: Aetna Medicare |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.98
|
| Rate for Payer: BCBS Complete |
$10.45
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$22.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.29
|
| 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 Commercial |
$22.21
|
| Rate for Payer: PHP Commercial |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.98
|
| Rate for Payer: Priority Health SBD |
$16.46
|
| Rate for Payer: UMR Bronson Commercial |
$9.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.60
|
|
|
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
|
$24.66
|
|
|
Service Code
|
NDC 00781322092
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$22.19 |
| Rate for Payer: Aetna American Axle |
$16.03
|
| Rate for Payer: Aetna Commercial |
$20.96
|
| Rate for Payer: Aetna Medicare |
$12.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.03
|
| Rate for Payer: BCBS Complete |
$9.86
|
| 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 |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.50
|
|
|
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
|
$28.57
|
|
|
Service Code
|
NDC 67457022810
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.71 |
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.57
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39.34
|
|
|
Service Code
|
NDC 63323042601
|
| Hospital Charge Code |
12734
|
|
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 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 |
$14.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.50
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.87
|
|
|
Service Code
|
NDC 00143925110
|
| Hospital Charge Code |
12734
|
|
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 Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.01
|
| 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: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.87
|
| 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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.87
|
|
|
Service Code
|
NDC 00143925110
|
| Hospital Charge Code |
12734
|
|
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 Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$19.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.01
|
| 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: PHP Commercial |
$19.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.87
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.15
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.45
|
|
|
Service Code
|
NDC 66794022902
|
| 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: Cofinity Medicare Advantage |
$13.62
|
| 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 Commercial |
$16.53
|
| Rate for Payer: PHP Commercial |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.64
|
| 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
|
|
