|
RISPERIDONE 1 MG TABLET
|
Facility
|
OP
|
$338.40
|
|
|
Service Code
|
NDC 00904635961
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: Aetna Medicare |
$169.20
|
| Rate for Payer: ASR ASR |
$328.25
|
| Rate for Payer: ASR Commercial |
$328.25
|
| Rate for Payer: BCBS Complete |
$135.36
|
| Rate for Payer: BCBS Trust/PPO |
$277.12
|
| Rate for Payer: BCN Commercial |
$262.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$318.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Healthscope Whirlpool |
$328.25
|
| Rate for Payer: Mclaren Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.64
|
| Rate for Payer: Nomi Health Commercial |
$277.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.51
|
| Rate for Payer: Priority Health Narrow Network |
$237.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.79
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$264.10
|
|
|
Service Code
|
NDC 00904736261
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.66 |
| Max. Negotiated Rate |
$264.10 |
| Rate for Payer: Aetna Commercial |
$237.69
|
| Rate for Payer: ASR ASR |
$256.18
|
| Rate for Payer: ASR Commercial |
$256.18
|
| Rate for Payer: BCBS Trust/PPO |
$215.22
|
| Rate for Payer: BCN Commercial |
$204.76
|
| Rate for Payer: Cash Price |
$211.28
|
| Rate for Payer: Cofinity Commercial |
$248.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.28
|
| Rate for Payer: Healthscope Commercial |
$264.10
|
| Rate for Payer: Healthscope Whirlpool |
$256.18
|
| Rate for Payer: Mclaren Commercial |
$237.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.48
|
| Rate for Payer: Nomi Health Commercial |
$216.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.41
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$39.48
|
|
|
Service Code
|
NDC 68382011414
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.66 |
| Max. Negotiated Rate |
$39.48 |
| Rate for Payer: Aetna Commercial |
$35.53
|
| Rate for Payer: ASR ASR |
$38.30
|
| Rate for Payer: ASR Commercial |
$38.30
|
| Rate for Payer: BCBS Trust/PPO |
$32.17
|
| Rate for Payer: BCN Commercial |
$30.61
|
| Rate for Payer: Cash Price |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$37.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$39.48
|
| Rate for Payer: Healthscope Whirlpool |
$38.30
|
| Rate for Payer: Mclaren Commercial |
$35.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.56
|
| Rate for Payer: Nomi Health Commercial |
$32.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.74
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,732.37 |
| Max. Negotiated Rate |
$2,665.18 |
| Rate for Payer: Aetna Commercial |
$2,398.66
|
| Rate for Payer: ASR ASR |
$2,585.22
|
| Rate for Payer: ASR Commercial |
$2,585.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.86
|
| Rate for Payer: BCN Commercial |
$2,066.31
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$2,505.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Healthscope Commercial |
$2,665.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,585.22
|
| Rate for Payer: Mclaren Commercial |
$2,398.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$2,185.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,345.36
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$2,665.18
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$2,665.18 |
| Rate for Payer: Aetna Commercial |
$2,398.66
|
| Rate for Payer: Aetna Medicare |
$31.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.79
|
| Rate for Payer: ASR ASR |
$2,585.22
|
| Rate for Payer: ASR Commercial |
$2,585.22
|
| Rate for Payer: BCBS Complete |
$17.91
|
| Rate for Payer: BCBS MAPPO |
$31.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.52
|
| Rate for Payer: BCN Commercial |
$2,066.31
|
| Rate for Payer: BCN Medicare Advantage |
$31.83
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cash Price |
$2,132.14
|
| Rate for Payer: Cofinity Commercial |
$2,505.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,132.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.83
|
| Rate for Payer: Healthscope Commercial |
$2,665.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,585.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$31.83
|
| Rate for Payer: Mclaren Commercial |
$2,398.66
|
| Rate for Payer: Mclaren Medicaid |
$17.06
|
| Rate for Payer: Mclaren Medicare |
$31.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.42
|
| Rate for Payer: Meridian Medicaid |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.40
|
| Rate for Payer: Nomi Health Commercial |
$2,185.45
|
| Rate for Payer: PACE Medicare |
$30.24
|
| Rate for Payer: PACE SWMI |
$31.83
|
| Rate for Payer: PHP Commercial |
$35.01
|
| Rate for Payer: PHP Medicaid |
$17.06
|
| Rate for Payer: PHP Medicare Advantage |
$31.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.89
|
| Rate for Payer: Priority Health Medicare |
$31.83
|
| Rate for Payer: Priority Health Narrow Network |
$25.51
|
| Rate for Payer: Railroad Medicare Medicare |
$31.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,345.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.83
|
| Rate for Payer: UHC Exchange |
$49.34
|
| Rate for Payer: UHC Medicare Advantage |
$31.83
|
| Rate for Payer: UHCCP DNSP |
$31.83
|
| Rate for Payer: UHCCP Medicaid |
$17.06
|
| Rate for Payer: VA VA |
$31.83
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
OP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.45 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: Aetna Medicare |
$770.56
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Complete |
$616.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.02
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,001.73 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.86
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,001.73 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,255.86
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
OP
|
$1,541.12
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.45 |
| Max. Negotiated Rate |
$1,541.12 |
| Rate for Payer: Aetna Commercial |
$1,387.01
|
| Rate for Payer: Aetna Medicare |
$770.56
|
| Rate for Payer: ASR ASR |
$1,494.89
|
| Rate for Payer: ASR Commercial |
$1,494.89
|
| Rate for Payer: BCBS Complete |
$616.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.02
|
| Rate for Payer: BCN Commercial |
$1,194.83
|
| Rate for Payer: Cash Price |
$1,232.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.90
|
| Rate for Payer: Healthscope Commercial |
$1,541.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,494.89
|
| Rate for Payer: Mclaren Commercial |
$1,387.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.95
|
| Rate for Payer: Nomi Health Commercial |
$1,263.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,350.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,356.19
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.33
|
|
|
Service Code
|
NDC 00409955850
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$29.33 |
| Rate for Payer: Aetna Commercial |
$26.40
|
| Rate for Payer: ASR ASR |
$28.45
|
| Rate for Payer: ASR Commercial |
$28.45
|
| Rate for Payer: BCBS Trust/PPO |
$23.90
|
| Rate for Payer: BCN Commercial |
$22.74
|
| Rate for Payer: Cash Price |
$23.46
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.46
|
| Rate for Payer: Healthscope Commercial |
$29.33
|
| Rate for Payer: Healthscope Whirlpool |
$28.45
|
| Rate for Payer: Mclaren Commercial |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.93
|
| Rate for Payer: Nomi Health Commercial |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.81
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.38
|
|
|
Service Code
|
NDC 00409955869
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: Aetna Medicare |
$12.69
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: ASR Commercial |
$24.62
|
| Rate for Payer: BCBS Complete |
$10.15
|
| Rate for Payer: BCBS Trust/PPO |
$20.78
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.24
|
| Rate for Payer: Priority Health Narrow Network |
$17.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$25.38 |
| Rate for Payer: Aetna Commercial |
$22.84
|
| Rate for Payer: ASR ASR |
$24.62
|
| Rate for Payer: ASR Commercial |
$24.62
|
| Rate for Payer: BCBS Trust/PPO |
$20.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: Cash Price |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.30
|
| Rate for Payer: Healthscope Commercial |
$25.38
|
| Rate for Payer: Healthscope Whirlpool |
$24.62
|
| Rate for Payer: Mclaren Commercial |
$22.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.57
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.33
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
NDC 72611075710
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$28.84
|
| Rate for Payer: ASR Commercial |
$28.84
|
| Rate for Payer: BCBS Trust/PPO |
$24.23
|
| 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 Commercial |
$25.27
|
| Rate for Payer: Nomi Health Commercial |
$24.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.16
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
NDC 43066000710
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: ASR ASR |
$23.28
|
| Rate for Payer: ASR Commercial |
$23.28
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$19.65
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$22.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Healthscope Whirlpool |
$23.28
|
| Rate for Payer: Mclaren Commercial |
$21.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.40
|
| Rate for Payer: Nomi Health Commercial |
$19.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.03
|
| Rate for Payer: Priority Health Narrow Network |
$16.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.86
|
|
|
Service Code
|
NDC 00781322095
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: ASR ASR |
$25.08
|
| Rate for Payer: ASR Commercial |
$25.08
|
| Rate for Payer: BCBS Trust/PPO |
$21.07
|
| Rate for Payer: BCN Commercial |
$20.05
|
| Rate for Payer: Cash Price |
$20.69
|
| Rate for Payer: Cofinity Commercial |
$24.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$25.86
|
| Rate for Payer: Healthscope Whirlpool |
$25.08
|
| Rate for Payer: Mclaren Commercial |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.98
|
| Rate for Payer: Nomi Health Commercial |
$21.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.76
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 39822420005
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: ASR ASR |
$22.10
|
| Rate for Payer: ASR Commercial |
$22.10
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| 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 Commercial |
$19.36
|
| Rate for Payer: Nomi Health Commercial |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.96
|
| Rate for Payer: Priority Health Narrow Network |
$15.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 39822420006
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: ASR ASR |
$22.10
|
| Rate for Payer: ASR Commercial |
$22.10
|
| Rate for Payer: BCBS Complete |
$9.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| 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 Commercial |
$19.36
|
| Rate for Payer: Nomi Health Commercial |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.96
|
| Rate for Payer: Priority Health Narrow Network |
$15.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
NDC 72611075701
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$29.73 |
| Rate for Payer: Aetna Commercial |
$26.76
|
| Rate for Payer: ASR ASR |
$28.84
|
| Rate for Payer: ASR Commercial |
$28.84
|
| Rate for Payer: BCBS Trust/PPO |
$24.23
|
| 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 Commercial |
$25.27
|
| Rate for Payer: Nomi Health Commercial |
$24.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.16
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.49
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$27.49 |
| Rate for Payer: Aetna Commercial |
$24.74
|
| Rate for Payer: Aetna Medicare |
$13.74
|
| Rate for Payer: ASR ASR |
$26.67
|
| Rate for Payer: ASR Commercial |
$26.67
|
| Rate for Payer: BCBS Complete |
$11.00
|
| Rate for Payer: BCBS Trust/PPO |
$22.51
|
| Rate for Payer: BCN Commercial |
$21.31
|
| Rate for Payer: Cash Price |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$25.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.99
|
| Rate for Payer: Healthscope Commercial |
$27.49
|
| Rate for Payer: Healthscope Whirlpool |
$26.67
|
| Rate for Payer: Mclaren Commercial |
$24.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.37
|
| Rate for Payer: Nomi Health Commercial |
$22.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.09
|
| Rate for Payer: Priority Health Narrow Network |
$19.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.19
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: ASR Commercial |
$23.37
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| 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 Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.11
|
| Rate for Payer: Priority Health Narrow Network |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
NDC 55150022610
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$27.53 |
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: ASR ASR |
$26.70
|
| Rate for Payer: ASR Commercial |
$26.70
|
| Rate for Payer: BCBS Trust/PPO |
$22.43
|
| 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 Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.23
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.14
|
|
|
Service Code
|
NDC 00781322092
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna Commercial |
$22.63
|
| Rate for Payer: ASR ASR |
$24.39
|
| Rate for Payer: ASR Commercial |
$24.39
|
| Rate for Payer: BCBS Trust/PPO |
$20.49
|
| Rate for Payer: BCN Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.11
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Healthscope Whirlpool |
$24.39
|
| Rate for Payer: Mclaren Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.37
|
| Rate for Payer: Nomi Health Commercial |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.14
|
|
|
Service Code
|
NDC 00781322092
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna Commercial |
$22.63
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: ASR ASR |
$24.39
|
| Rate for Payer: ASR Commercial |
$24.39
|
| Rate for Payer: BCBS Complete |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$20.59
|
| Rate for Payer: BCN Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Cofinity Commercial |
$23.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.11
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Healthscope Whirlpool |
$24.39
|
| Rate for Payer: Mclaren Commercial |
$22.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.37
|
| Rate for Payer: Nomi Health Commercial |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.03
|
| Rate for Payer: Priority Health Narrow Network |
$17.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.12
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 39822420005
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$22.78 |
| Rate for Payer: Aetna Commercial |
$20.50
|
| Rate for Payer: ASR ASR |
$22.10
|
| Rate for Payer: ASR Commercial |
$22.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.56
|
| 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 Commercial |
$19.36
|
| Rate for Payer: Nomi Health Commercial |
$18.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.05
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420001
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: ASR Commercial |
$23.37
|
| Rate for Payer: BCBS Complete |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| 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 Commercial |
$20.48
|
| Rate for Payer: Nomi Health Commercial |
$19.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.11
|
| Rate for Payer: Priority Health Narrow Network |
$16.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
