Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$24.09

Service Code	NDC 39822-4200-2
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$24.09
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: ASR ASR	$23.37
Rate for Payer: BCBS Trust/PPO	$18.68
Rate for Payer: BCN Commercial	$18.68
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cofinity Commercial	$22.64
Rate for Payer: Encore Health Key Benefits Commercial	$19.27
Rate for Payer: Healthscope Commercial	$24.09
Rate for Payer: Healthscope Whirlpool	$23.37
Rate for Payer: Mclaren Commercial	$21.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.48
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.20

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$29.53

Service Code	NDC 0781-3220-92
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$20.67
Max. Negotiated Rate	$29.53
Rate for Payer: Aetna Commercial	$26.58
Rate for Payer: ASR ASR	$28.64
Rate for Payer: BCBS Trust/PPO	$22.89
Rate for Payer: BCN Commercial	$22.89
Rate for Payer: Cash Price	$23.62
Rate for Payer: Cofinity Commercial	$27.76
Rate for Payer: Encore Health Key Benefits Commercial	$23.62
Rate for Payer: Healthscope Commercial	$29.53
Rate for Payer: Healthscope Whirlpool	$28.64
Rate for Payer: Mclaren Commercial	$26.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.10
Rate for Payer: Priority Health Cigna Priority Health	$20.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.99

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$29.73

Service Code	NDC 72611-757-01
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$29.73
Rate for Payer: Aetna Commercial	$26.76
Rate for Payer: ASR ASR	$28.84
Rate for Payer: BCBS Trust/PPO	$23.05
Rate for Payer: BCN Commercial	$23.05
Rate for Payer: Cash Price	$23.78
Rate for Payer: Cofinity Commercial	$27.95
Rate for Payer: Encore Health Key Benefits Commercial	$23.78
Rate for Payer: Healthscope Commercial	$29.73
Rate for Payer: Healthscope Whirlpool	$28.84
Rate for Payer: Mclaren Commercial	$26.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.27
Rate for Payer: Priority Health Cigna Priority Health	$20.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.16

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$23.49

Service Code	NDC 0409-9558-05
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$23.49
Rate for Payer: Aetna Commercial	$21.14
Rate for Payer: ASR ASR	$22.79
Rate for Payer: BCBS Trust/PPO	$18.21
Rate for Payer: BCN Commercial	$18.21
Rate for Payer: Cash Price	$18.79
Rate for Payer: Cofinity Commercial	$22.08
Rate for Payer: Encore Health Key Benefits Commercial	$18.79
Rate for Payer: Healthscope Commercial	$23.49
Rate for Payer: Healthscope Whirlpool	$22.79
Rate for Payer: Mclaren Commercial	$21.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.97
Rate for Payer: Priority Health Cigna Priority Health	$16.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.67

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$15.98

Service Code	NDC 0781-3220-95
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$15.98
Rate for Payer: Aetna Commercial	$14.38
Rate for Payer: ASR ASR	$15.50
Rate for Payer: BCBS Trust/PPO	$12.39
Rate for Payer: BCN Commercial	$12.39
Rate for Payer: Cash Price	$12.79
Rate for Payer: Cofinity Commercial	$15.02
Rate for Payer: Encore Health Key Benefits Commercial	$12.78
Rate for Payer: Healthscope Commercial	$15.98
Rate for Payer: Healthscope Whirlpool	$15.50
Rate for Payer: Mclaren Commercial	$14.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.58
Rate for Payer: Priority Health Cigna Priority Health	$11.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.06

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$18.65

Service Code	NDC 43066-013-10
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$18.65
Rate for Payer: Aetna Commercial	$16.78
Rate for Payer: ASR ASR	$18.09
Rate for Payer: BCBS Trust/PPO	$14.46
Rate for Payer: BCN Commercial	$14.46
Rate for Payer: Cash Price	$14.92
Rate for Payer: Cofinity Commercial	$17.53
Rate for Payer: Encore Health Key Benefits Commercial	$14.92
Rate for Payer: Healthscope Commercial	$18.65
Rate for Payer: Healthscope Whirlpool	$18.09
Rate for Payer: Mclaren Commercial	$16.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.85
Rate for Payer: Priority Health Cigna Priority Health	$13.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.41

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$22.78

Service Code	NDC 39822-4200-5
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$22.78
Rate for Payer: Aetna Commercial	$20.50
Rate for Payer: ASR ASR	$22.10
Rate for Payer: BCBS Trust/PPO	$17.66
Rate for Payer: BCN Commercial	$17.66
Rate for Payer: Cash Price	$18.23
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Encore Health Key Benefits Commercial	$18.22
Rate for Payer: Healthscope Commercial	$22.78
Rate for Payer: Healthscope Whirlpool	$22.10
Rate for Payer: Mclaren Commercial	$20.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.36
Rate for Payer: Priority Health Cigna Priority Health	$15.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.05

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$17.20

Service Code	NDC 43066-007-10
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$17.20
Rate for Payer: Aetna Commercial	$15.48
Rate for Payer: ASR ASR	$16.68
Rate for Payer: BCBS Trust/PPO	$13.34
Rate for Payer: BCN Commercial	$13.34
Rate for Payer: Cash Price	$13.76
Rate for Payer: Cofinity Commercial	$16.17
Rate for Payer: Encore Health Key Benefits Commercial	$13.76
Rate for Payer: Healthscope Commercial	$17.20
Rate for Payer: Healthscope Whirlpool	$16.68
Rate for Payer: Mclaren Commercial	$15.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.62
Rate for Payer: Priority Health Cigna Priority Health	$12.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.14

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$29.73

Service Code	NDC 72611-757-10
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$20.81
Max. Negotiated Rate	$29.73
Rate for Payer: Aetna Commercial	$26.76
Rate for Payer: ASR ASR	$28.84
Rate for Payer: BCBS Trust/PPO	$23.05
Rate for Payer: BCN Commercial	$23.05
Rate for Payer: Cash Price	$23.78
Rate for Payer: Cofinity Commercial	$27.95
Rate for Payer: Encore Health Key Benefits Commercial	$23.78
Rate for Payer: Healthscope Commercial	$29.73
Rate for Payer: Healthscope Whirlpool	$28.84
Rate for Payer: Mclaren Commercial	$26.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.27
Rate for Payer: Priority Health Cigna Priority Health	$20.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.16

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$22.78

Service Code	NDC 39822-4200-6
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$22.78
Rate for Payer: Aetna Commercial	$20.50
Rate for Payer: ASR ASR	$22.10
Rate for Payer: BCBS Trust/PPO	$17.66
Rate for Payer: BCN Commercial	$17.66
Rate for Payer: Cash Price	$18.23
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Encore Health Key Benefits Commercial	$18.22
Rate for Payer: Healthscope Commercial	$22.78
Rate for Payer: Healthscope Whirlpool	$22.10
Rate for Payer: Mclaren Commercial	$20.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.36
Rate for Payer: Priority Health Cigna Priority Health	$15.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.05

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$23.49

Service Code	NDC 0409-9558-69
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$23.49
Rate for Payer: Aetna Commercial	$21.14
Rate for Payer: ASR ASR	$22.79
Rate for Payer: BCBS Trust/PPO	$18.21
Rate for Payer: BCN Commercial	$18.21
Rate for Payer: Cash Price	$18.79
Rate for Payer: Cofinity Commercial	$22.08
Rate for Payer: Encore Health Key Benefits Commercial	$18.79
Rate for Payer: Healthscope Commercial	$23.49
Rate for Payer: Healthscope Whirlpool	$22.79
Rate for Payer: Mclaren Commercial	$21.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.97
Rate for Payer: Priority Health Cigna Priority Health	$16.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.67

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$26.12

Service Code	NDC 0409-9558-50
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$18.28
Max. Negotiated Rate	$26.12
Rate for Payer: Aetna Commercial	$23.51
Rate for Payer: ASR ASR	$25.34
Rate for Payer: BCBS Trust/PPO	$20.25
Rate for Payer: BCN Commercial	$20.25
Rate for Payer: Cash Price	$20.90
Rate for Payer: Cofinity Commercial	$24.55
Rate for Payer: Encore Health Key Benefits Commercial	$20.90
Rate for Payer: Healthscope Commercial	$26.12
Rate for Payer: Healthscope Whirlpool	$25.34
Rate for Payer: Mclaren Commercial	$23.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.20
Rate for Payer: Priority Health Cigna Priority Health	$18.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$22.99

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$28.97

Service Code	NDC 67457-228-99
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$28.97
Rate for Payer: Aetna Commercial	$26.07
Rate for Payer: ASR ASR	$28.10
Rate for Payer: BCBS Trust/PPO	$22.46
Rate for Payer: BCN Commercial	$22.46
Rate for Payer: Cash Price	$23.18
Rate for Payer: Cofinity Commercial	$27.23
Rate for Payer: Encore Health Key Benefits Commercial	$23.18
Rate for Payer: Healthscope Commercial	$28.97
Rate for Payer: Healthscope Whirlpool	$28.10
Rate for Payer: Mclaren Commercial	$26.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.62
Rate for Payer: Priority Health Cigna Priority Health	$20.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.49

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$17.54

Service Code	NDC 25021-662-05
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$17.54
Rate for Payer: Aetna Commercial	$15.79
Rate for Payer: ASR ASR	$17.01
Rate for Payer: BCBS Trust/PPO	$13.60
Rate for Payer: BCN Commercial	$13.60
Rate for Payer: Cash Price	$14.03
Rate for Payer: Cofinity Commercial	$16.49
Rate for Payer: Encore Health Key Benefits Commercial	$14.03
Rate for Payer: Healthscope Commercial	$17.54
Rate for Payer: Healthscope Whirlpool	$17.01
Rate for Payer: Mclaren Commercial	$15.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$12.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.44

ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION

Facility

$27.53

Service Code	NDC 55150-226-10
Hospital Charge Code	12734
Hospital Revenue Code	250
Min. Negotiated Rate	$19.27
Max. Negotiated Rate	$27.53
Rate for Payer: Aetna Commercial	$24.78
Rate for Payer: ASR ASR	$26.70
Rate for Payer: BCBS Trust/PPO	$21.34
Rate for Payer: BCN Commercial	$21.34
Rate for Payer: Cash Price	$22.02
Rate for Payer: Cofinity Commercial	$25.88
Rate for Payer: Encore Health Key Benefits Commercial	$22.02
Rate for Payer: Healthscope Commercial	$27.53
Rate for Payer: Healthscope Whirlpool	$26.70
Rate for Payer: Mclaren Commercial	$24.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.40
Rate for Payer: Priority Health Cigna Priority Health	$19.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.23

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$22.78

Service Code	NDC 39822-4200-5
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$22.78
Rate for Payer: Aetna Commercial	$20.50
Rate for Payer: ASR ASR	$22.10
Rate for Payer: BCBS Trust/PPO	$17.66
Rate for Payer: BCN Commercial	$17.66
Rate for Payer: Cash Price	$18.23
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Encore Health Key Benefits Commercial	$18.22
Rate for Payer: Healthscope Commercial	$22.78
Rate for Payer: Healthscope Whirlpool	$22.10
Rate for Payer: Mclaren Commercial	$20.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.36
Rate for Payer: Priority Health Cigna Priority Health	$15.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.05

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$28.97

Service Code	NDC 67457-228-99
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$28.97
Rate for Payer: Aetna Commercial	$26.07
Rate for Payer: ASR ASR	$28.10
Rate for Payer: BCBS Trust/PPO	$22.46
Rate for Payer: BCN Commercial	$22.46
Rate for Payer: Cash Price	$23.18
Rate for Payer: Cofinity Commercial	$27.23
Rate for Payer: Encore Health Key Benefits Commercial	$23.18
Rate for Payer: Healthscope Commercial	$28.97
Rate for Payer: Healthscope Whirlpool	$28.10
Rate for Payer: Mclaren Commercial	$26.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.62
Rate for Payer: Priority Health Cigna Priority Health	$20.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.49

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$24.09

Service Code	NDC 39822-4200-2
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$24.09
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: ASR ASR	$23.37
Rate for Payer: BCBS Trust/PPO	$18.68
Rate for Payer: BCN Commercial	$18.68
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cofinity Commercial	$22.64
Rate for Payer: Encore Health Key Benefits Commercial	$19.27
Rate for Payer: Healthscope Commercial	$24.09
Rate for Payer: Healthscope Whirlpool	$23.37
Rate for Payer: Mclaren Commercial	$21.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.48
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.20

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$24.09

Service Code	NDC 39822-4200-1
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$24.09
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: ASR ASR	$23.37
Rate for Payer: BCBS Trust/PPO	$18.68
Rate for Payer: BCN Commercial	$18.68
Rate for Payer: Cash Price	$19.27
Rate for Payer: Cofinity Commercial	$22.64
Rate for Payer: Encore Health Key Benefits Commercial	$19.27
Rate for Payer: Healthscope Commercial	$24.09
Rate for Payer: Healthscope Whirlpool	$23.37
Rate for Payer: Mclaren Commercial	$21.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.48
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.20

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$28.97

Service Code	NDC 67457-228-10
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$20.28
Max. Negotiated Rate	$28.97
Rate for Payer: Aetna Commercial	$26.07
Rate for Payer: ASR ASR	$28.10
Rate for Payer: BCBS Trust/PPO	$22.46
Rate for Payer: BCN Commercial	$22.46
Rate for Payer: Cash Price	$23.18
Rate for Payer: Cofinity Commercial	$27.23
Rate for Payer: Encore Health Key Benefits Commercial	$23.18
Rate for Payer: Healthscope Commercial	$28.97
Rate for Payer: Healthscope Whirlpool	$28.10
Rate for Payer: Mclaren Commercial	$26.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.62
Rate for Payer: Priority Health Cigna Priority Health	$20.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.49

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$17.54

Service Code	NDC 25021-662-05
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$12.28
Max. Negotiated Rate	$17.54
Rate for Payer: Aetna Commercial	$15.79
Rate for Payer: ASR ASR	$17.01
Rate for Payer: BCBS Trust/PPO	$13.60
Rate for Payer: BCN Commercial	$13.60
Rate for Payer: Cash Price	$14.03
Rate for Payer: Cofinity Commercial	$16.49
Rate for Payer: Encore Health Key Benefits Commercial	$14.03
Rate for Payer: Healthscope Commercial	$17.54
Rate for Payer: Healthscope Whirlpool	$17.01
Rate for Payer: Mclaren Commercial	$15.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$12.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$15.44

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$22.78

Service Code	NDC 39822-4200-6
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$15.95
Max. Negotiated Rate	$22.78
Rate for Payer: Aetna Commercial	$20.50
Rate for Payer: ASR ASR	$22.10
Rate for Payer: BCBS Trust/PPO	$17.66
Rate for Payer: BCN Commercial	$17.66
Rate for Payer: Cash Price	$18.23
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Encore Health Key Benefits Commercial	$18.22
Rate for Payer: Healthscope Commercial	$22.78
Rate for Payer: Healthscope Whirlpool	$22.10
Rate for Payer: Mclaren Commercial	$20.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.36
Rate for Payer: Priority Health Cigna Priority Health	$15.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.05

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$23.49

Service Code	NDC 0409-9558-05
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$23.49
Rate for Payer: Aetna Commercial	$21.14
Rate for Payer: ASR ASR	$22.79
Rate for Payer: BCBS Trust/PPO	$18.21
Rate for Payer: BCN Commercial	$18.21
Rate for Payer: Cash Price	$18.79
Rate for Payer: Cofinity Commercial	$22.08
Rate for Payer: Encore Health Key Benefits Commercial	$18.79
Rate for Payer: Healthscope Commercial	$23.49
Rate for Payer: Healthscope Whirlpool	$22.79
Rate for Payer: Mclaren Commercial	$21.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.97
Rate for Payer: Priority Health Cigna Priority Health	$16.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.67

ROCURONIUM 10 MG/ML IV (CODE)

Facility

$23.49

Service Code	NDC 0409-9558-49
Hospital Charge Code	163721
Hospital Revenue Code	250
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$23.49
Rate for Payer: Aetna Commercial	$21.14
Rate for Payer: ASR ASR	$22.79
Rate for Payer: BCBS Trust/PPO	$18.21
Rate for Payer: BCN Commercial	$18.21
Rate for Payer: Cash Price	$18.79
Rate for Payer: Cofinity Commercial	$22.08
Rate for Payer: Encore Health Key Benefits Commercial	$18.79
Rate for Payer: Healthscope Commercial	$23.49
Rate for Payer: Healthscope Whirlpool	$22.79
Rate for Payer: Mclaren Commercial	$21.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.97
Rate for Payer: Priority Health Cigna Priority Health	$16.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.67

ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION

Facility

$11,242.83

Service Code	HCPCS J2796
Hospital Charge Code	93566
Hospital Revenue Code	636
Min. Negotiated Rate	$7,869.98
Max. Negotiated Rate	$11,242.83
Rate for Payer: Aetna Commercial	$10,118.55
Rate for Payer: ASR ASR	$10,905.55
Rate for Payer: BCBS Trust/PPO	$8,716.57
Rate for Payer: BCN Commercial	$8,716.57
Rate for Payer: Cash Price	$8,994.26
Rate for Payer: Cofinity Commercial	$10,568.26
Rate for Payer: Encore Health Key Benefits Commercial	$8,994.26
Rate for Payer: Healthscope Commercial	$11,242.83
Rate for Payer: Healthscope Whirlpool	$10,905.55
Rate for Payer: Mclaren Commercial	$10,118.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,556.41
Rate for Payer: Priority Health Cigna Priority Health	$7,869.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$9,893.69

Know your out-of-pocket cost for care.

All Charges