|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$25.38
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$17.54 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: ASR ASR |
$17.01
|
| Rate for Payer: ASR Commercial |
$17.01
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| 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 Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.44
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$27.49
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$27.49 |
| Rate for Payer: Aetna Commercial |
$24.74
|
| Rate for Payer: ASR ASR |
$26.67
|
| Rate for Payer: ASR Commercial |
$26.67
|
| Rate for Payer: BCBS Trust/PPO |
$22.40
|
| 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: UHC All Payor (Choice/PPO) + Core |
$24.19
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$25.38
|
|
|
Service Code
|
NDC 00409955849
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420001
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 39822420006
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457022810
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: ASR ASR |
$28.10
|
| Rate for Payer: ASR Commercial |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.61
|
| 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 Commercial |
$24.62
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.49
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
NDC 25021066205
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$17.54 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: ASR ASR |
$17.01
|
| Rate for Payer: ASR Commercial |
$17.01
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| 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 Commercial |
$14.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.44
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$28.97
|
|
|
Service Code
|
NDC 67457022899
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: ASR ASR |
$28.10
|
| Rate for Payer: ASR Commercial |
$28.10
|
| Rate for Payer: BCBS Complete |
$11.59
|
| Rate for Payer: BCBS Trust/PPO |
$23.72
|
| 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 Commercial |
$24.62
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.38
|
| Rate for Payer: Priority Health Narrow Network |
$20.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.49
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 39822420006
|
| Hospital Charge Code |
163721
|
|
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 IV (CODE)
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457022899
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: ASR ASR |
$28.10
|
| Rate for Payer: ASR Commercial |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$23.61
|
| 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 Commercial |
$24.62
|
| Rate for Payer: Nomi Health Commercial |
$23.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.49
|
|
|
ROCURONIUM 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 39822420002
|
| Hospital Charge Code |
163721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.66 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: ASR Commercial |
$23.37
|
| Rate for Payer: BCBS Trust/PPO |
$19.63
|
| 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: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$6,816.32
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,430.61 |
| Max. Negotiated Rate |
$6,816.32 |
| Rate for Payer: Aetna Commercial |
$6,134.69
|
| Rate for Payer: ASR ASR |
$6,611.83
|
| Rate for Payer: ASR Commercial |
$6,611.83
|
| Rate for Payer: BCBS Trust/PPO |
$5,554.62
|
| Rate for Payer: BCN Commercial |
$5,284.69
|
| Rate for Payer: Cash Price |
$5,453.05
|
| Rate for Payer: Cofinity Commercial |
$6,407.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,453.06
|
| Rate for Payer: Healthscope Commercial |
$6,816.32
|
| Rate for Payer: Healthscope Whirlpool |
$6,611.83
|
| Rate for Payer: Mclaren Commercial |
$6,134.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,793.87
|
| Rate for Payer: Nomi Health Commercial |
$5,589.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,430.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,998.36
|
|
|
ROMIPLOSTIM 250 MCG SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$6,816.32
|
|
|
Service Code
|
HCPCS J2802
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$6,816.32 |
| Rate for Payer: Aetna Commercial |
$6,134.69
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.18
|
| Rate for Payer: ASR ASR |
$6,611.83
|
| Rate for Payer: ASR Commercial |
$6,611.83
|
| Rate for Payer: BCBS Complete |
$5.93
|
| Rate for Payer: BCBS MAPPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$5,581.88
|
| Rate for Payer: BCN Commercial |
$5,284.69
|
| Rate for Payer: BCN Medicare Advantage |
$10.54
|
| Rate for Payer: Cash Price |
$5,453.05
|
| Rate for Payer: Cash Price |
$5,453.05
|
| Rate for Payer: Cofinity Commercial |
$6,407.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,453.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.54
|
| Rate for Payer: Healthscope Commercial |
$6,816.32
|
| Rate for Payer: Healthscope Whirlpool |
$6,611.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$10.54
|
| Rate for Payer: Mclaren Commercial |
$6,134.69
|
| Rate for Payer: Mclaren Medicaid |
$5.65
|
| Rate for Payer: Mclaren Medicare |
$10.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.07
|
| Rate for Payer: Meridian Medicaid |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,793.87
|
| Rate for Payer: Nomi Health Commercial |
$5,589.38
|
| Rate for Payer: PACE Medicare |
$10.01
|
| Rate for Payer: PACE SWMI |
$10.54
|
| Rate for Payer: PHP Commercial |
$11.59
|
| Rate for Payer: PHP Medicaid |
$5.65
|
| Rate for Payer: PHP Medicare Advantage |
$10.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,430.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.91
|
| Rate for Payer: Priority Health Medicare |
$10.54
|
| Rate for Payer: Priority Health Narrow Network |
$8.73
|
| Rate for Payer: Railroad Medicare Medicare |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,998.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.54
|
| Rate for Payer: UHC Exchange |
$16.34
|
| Rate for Payer: UHC Medicare Advantage |
$10.54
|
| Rate for Payer: UHCCP DNSP |
$10.54
|
| Rate for Payer: UHCCP Medicaid |
$5.65
|
| Rate for Payer: VA VA |
$10.54
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$4,005.98
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$4,005.98 |
| Rate for Payer: Aetna Commercial |
$3,605.38
|
| Rate for Payer: Aetna Medicare |
$11.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.36
|
| Rate for Payer: ASR ASR |
$3,885.80
|
| Rate for Payer: ASR Commercial |
$3,885.80
|
| Rate for Payer: BCBS Complete |
$6.47
|
| Rate for Payer: BCBS MAPPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,280.50
|
| Rate for Payer: BCN Commercial |
$3,105.84
|
| Rate for Payer: BCN Medicare Advantage |
$11.49
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,765.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.49
|
| Rate for Payer: Healthscope Commercial |
$4,005.98
|
| Rate for Payer: Healthscope Whirlpool |
$3,885.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$11.49
|
| Rate for Payer: Mclaren Commercial |
$3,605.38
|
| Rate for Payer: Mclaren Medicaid |
$6.16
|
| Rate for Payer: Mclaren Medicare |
$11.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Medicaid |
$6.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.08
|
| Rate for Payer: Nomi Health Commercial |
$3,284.90
|
| Rate for Payer: PACE Medicare |
$10.92
|
| Rate for Payer: PACE SWMI |
$11.49
|
| Rate for Payer: PHP Commercial |
$12.64
|
| Rate for Payer: PHP Medicaid |
$6.16
|
| Rate for Payer: PHP Medicare Advantage |
$11.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.93
|
| Rate for Payer: Priority Health Medicare |
$11.49
|
| Rate for Payer: Priority Health Narrow Network |
$9.54
|
| Rate for Payer: Railroad Medicare Medicare |
$11.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,525.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.49
|
| Rate for Payer: UHC Exchange |
$17.81
|
| Rate for Payer: UHC Medicare Advantage |
$11.49
|
| Rate for Payer: UHCCP DNSP |
$11.49
|
| Rate for Payer: UHCCP Medicaid |
$6.16
|
| Rate for Payer: VA VA |
$11.49
|
|
|
ROMOSOZUMAB-AQQG 210 MG/2.34 ML(105 MG/1.17 ML X2)SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$4,005.98
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
190169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,603.89 |
| Max. Negotiated Rate |
$4,005.98 |
| Rate for Payer: Aetna Commercial |
$3,605.38
|
| Rate for Payer: ASR ASR |
$3,885.80
|
| Rate for Payer: ASR Commercial |
$3,885.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,264.47
|
| Rate for Payer: BCN Commercial |
$3,105.84
|
| Rate for Payer: Cash Price |
$3,204.79
|
| Rate for Payer: Cofinity Commercial |
$3,765.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,204.78
|
| Rate for Payer: Healthscope Commercial |
$4,005.98
|
| Rate for Payer: Healthscope Whirlpool |
$3,885.80
|
| Rate for Payer: Mclaren Commercial |
$3,605.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.08
|
| Rate for Payer: Nomi Health Commercial |
$3,284.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,603.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,525.26
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
IP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.03 |
| Max. Negotiated Rate |
$360.05 |
| Rate for Payer: Aetna Commercial |
$324.04
|
| Rate for Payer: ASR ASR |
$349.25
|
| Rate for Payer: ASR Commercial |
$349.25
|
| Rate for Payer: BCBS Trust/PPO |
$293.40
|
| Rate for Payer: BCN Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$288.04
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.04
|
| Rate for Payer: Healthscope Commercial |
$360.05
|
| Rate for Payer: Healthscope Whirlpool |
$349.25
|
| Rate for Payer: Mclaren Commercial |
$324.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.04
|
| Rate for Payer: Nomi Health Commercial |
$295.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.84
|
|
|
ROPINIROLE 1 MG TABLET
|
Facility
|
OP
|
$360.05
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.02 |
| Max. Negotiated Rate |
$360.05 |
| Rate for Payer: Aetna Commercial |
$324.04
|
| Rate for Payer: Aetna Medicare |
$180.02
|
| Rate for Payer: ASR ASR |
$349.25
|
| Rate for Payer: ASR Commercial |
$349.25
|
| Rate for Payer: BCBS Complete |
$144.02
|
| Rate for Payer: BCBS Trust/PPO |
$294.84
|
| Rate for Payer: BCN Commercial |
$279.15
|
| Rate for Payer: Cash Price |
$288.04
|
| Rate for Payer: Cofinity Commercial |
$338.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.04
|
| Rate for Payer: Healthscope Commercial |
$360.05
|
| Rate for Payer: Healthscope Whirlpool |
$349.25
|
| Rate for Payer: Mclaren Commercial |
$324.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.04
|
| Rate for Payer: Nomi Health Commercial |
$295.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.48
|
| Rate for Payer: Priority Health Narrow Network |
$252.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.84
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) CUSTOM INJECTION
|
Facility
|
IP
|
$18.12
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) CUSTOM INJECTION
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
300612
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$18.12 |
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.84
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$147.20
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$132.48
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Commercial |
$65.16
|
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: ASR ASR |
$70.23
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR ASR |
$142.78
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: ASR Commercial |
$70.23
|
| Rate for Payer: ASR Commercial |
$6.21
|
| Rate for Payer: ASR Commercial |
$142.78
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: BCBS Trust/PPO |
$59.00
|
| Rate for Payer: BCBS Trust/PPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$119.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$14.77
|
| Rate for Payer: BCN Commercial |
$114.12
|
| Rate for Payer: BCN Commercial |
$56.13
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: BCN Commercial |
$4.96
|
| Rate for Payer: Cash Price |
$117.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cofinity Commercial |
$138.37
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$68.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.76
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$72.40
|
| Rate for Payer: Healthscope Whirlpool |
$70.23
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Healthscope Whirlpool |
$142.78
|
| Rate for Payer: Healthscope Whirlpool |
$6.21
|
| Rate for Payer: Mclaren Commercial |
$132.48
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$65.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$120.70
|
| Rate for Payer: Nomi Health Commercial |
$59.37
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.63
|
|
|
ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$147.20
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
18192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$132.48
|
| Rate for Payer: Aetna Commercial |
$5.76
|
| Rate for Payer: Aetna Commercial |
$10.98
|
| Rate for Payer: Aetna Commercial |
$65.16
|
| Rate for Payer: Aetna Commercial |
$16.31
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Aetna Medicare |
$73.60
|
| Rate for Payer: Aetna Medicare |
$3.20
|
| Rate for Payer: Aetna Medicare |
$36.20
|
| Rate for Payer: ASR ASR |
$11.83
|
| Rate for Payer: ASR ASR |
$6.21
|
| Rate for Payer: ASR ASR |
$142.78
|
| Rate for Payer: ASR ASR |
$17.58
|
| Rate for Payer: ASR ASR |
$70.23
|
| Rate for Payer: ASR Commercial |
$11.83
|
| Rate for Payer: ASR Commercial |
$142.78
|
| Rate for Payer: ASR Commercial |
$70.23
|
| Rate for Payer: ASR Commercial |
$6.21
|
| Rate for Payer: ASR Commercial |
$17.58
|
| Rate for Payer: BCBS Complete |
$28.96
|
| Rate for Payer: BCBS Complete |
$4.88
|
| Rate for Payer: BCBS Complete |
$58.88
|
| Rate for Payer: BCBS Complete |
$7.25
|
| Rate for Payer: BCBS Complete |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$120.54
|
| Rate for Payer: BCBS Trust/PPO |
$59.29
|
| Rate for Payer: BCN Commercial |
$4.96
|
| Rate for Payer: BCN Commercial |
$9.46
|
| Rate for Payer: BCN Commercial |
$114.12
|
| Rate for Payer: BCN Commercial |
$14.05
|
| Rate for Payer: BCN Commercial |
$56.13
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$117.76
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$14.50
|
| Rate for Payer: Cash Price |
$5.12
|
| Rate for Payer: Cash Price |
$9.76
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$117.76
|
| Rate for Payer: Cofinity Commercial |
$138.37
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Cofinity Commercial |
$68.06
|
| Rate for Payer: Cofinity Commercial |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$17.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.50
|
| Rate for Payer: Healthscope Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$12.20
|
| Rate for Payer: Healthscope Whirlpool |
$70.23
|
| Rate for Payer: Healthscope Whirlpool |
$142.78
|
| Rate for Payer: Healthscope Whirlpool |
$11.83
|
| Rate for Payer: Healthscope Whirlpool |
$6.21
|
| Rate for Payer: Healthscope Whirlpool |
$17.58
|
| Rate for Payer: Mclaren Commercial |
$5.76
|
| Rate for Payer: Mclaren Commercial |
$10.98
|
| Rate for Payer: Mclaren Commercial |
$132.48
|
| Rate for Payer: Mclaren Commercial |
$16.31
|
| Rate for Payer: Mclaren Commercial |
$65.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.40
|
| Rate for Payer: Nomi Health Commercial |
$10.00
|
| Rate for Payer: Nomi Health Commercial |
$120.70
|
| Rate for Payer: Nomi Health Commercial |
$59.37
|
| Rate for Payer: Nomi Health Commercial |
$5.25
|
| Rate for Payer: Nomi Health Commercial |
$14.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.95
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: Aetna Medicare |
$10.34
|
| Rate for Payer: Aetna Medicare |
$12.42
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$26.41
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$26.41
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$9.93
|
| Rate for Payer: BCBS Complete |
$10.89
|
| Rate for Payer: BCBS Trust/PPO |
$22.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$20.33
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: BCN Commercial |
$21.11
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Cofinity Commercial |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Healthscope Commercial |
$27.23
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Whirlpool |
$26.41
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$24.51
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$22.33
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.06
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: Priority Health Narrow Network |
$0.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.96
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.83
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
153276
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$22.35
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$24.09
|
| Rate for Payer: ASR ASR |
$26.41
|
| Rate for Payer: ASR Commercial |
$24.09
|
| Rate for Payer: ASR Commercial |
$20.07
|
| Rate for Payer: ASR Commercial |
$26.41
|
| Rate for Payer: BCBS Trust/PPO |
$22.19
|
| Rate for Payer: BCBS Trust/PPO |
$16.86
|
| Rate for Payer: BCBS Trust/PPO |
$20.23
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$21.11
|
| Rate for Payer: BCN Commercial |
$19.25
|
| Rate for Payer: Cash Price |
$19.86
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$21.79
|
| Rate for Payer: Cofinity Commercial |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$24.83
|
| Rate for Payer: Healthscope Commercial |
$27.23
|
| Rate for Payer: Healthscope Whirlpool |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$26.41
|
| Rate for Payer: Mclaren Commercial |
$22.35
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$22.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
