|
ROBE BLUE XLRG
|
Facility
|
OP
|
$34.55
|
|
| Hospital Charge Code |
270658572C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$17.27 |
| Rate for Payer: Aetna Commercial |
$10.37
|
| Rate for Payer: Aetna Medicare Advantage |
$10.37
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.81
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.81
|
| Rate for Payer: Cigna Commercial |
$17.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.49
|
| Rate for Payer: Oxford Commercial |
$17.27
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.18
|
| Rate for Payer: UnitedHealthcare Commercial |
$17.27
|
|
|
ROBE BLUE XLRG
|
Facility
|
IP
|
$34.55
|
|
| Hospital Charge Code |
270658572C
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$5.18
|
|
|
ROBINUL/0.2MG/1ML
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
60633829
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Medicare Advantage |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$3.83
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$3.83
|
| Rate for Payer: Cigna Commercial |
$7.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$1.95
|
| Rate for Payer: Oxford Commercial |
$7.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$7.50
|
|
|
ROBINUL/0.2MG/1ML
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
60633829
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.25
|
|
|
ROBINUL/0.2MG/1ML
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
60633828
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Medicare Advantage |
$9.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$8.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$8.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$8.16
|
| Rate for Payer: Cigna Commercial |
$16.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$4.16
|
| Rate for Payer: Oxford Commercial |
$16.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$16.00
|
|
|
ROBINUL/0.2MG/1ML
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
60633828
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$4.80
|
|
|
ROBITUSSIN/100MG/5ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ROBITUSSIN/100MG/5ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
ROBITUSSIN/100MG/5ML
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60633832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
ROBITUSSIN/100MG/5ML
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
60633831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
|
|
ROBITUSSIN/100MG/5ML
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60633831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.26
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.13
|
| Rate for Payer: Oxford Commercial |
$0.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.50
|
|
|
ROBITUSSIN/100MG/5ML
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
60633832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Aetna Commercial |
$0.30
|
| Rate for Payer: Aetna Medicare Advantage |
$0.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.26
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.26
|
| Rate for Payer: Cigna Commercial |
$0.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.13
|
| Rate for Payer: Oxford Commercial |
$0.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$0.50
|
|
|
ROBITUSSIN/5ML/U/D
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60634867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
ROBITUSSIN/5ML/U/D
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60634867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ROBITUSSIN CF
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
60634436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
|
|
ROBITUSSIN CF
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
60634436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare Advantage |
$2.10
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$1.78
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$1.78
|
| Rate for Payer: Cigna Commercial |
$3.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.91
|
| Rate for Payer: Oxford Commercial |
$3.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$1.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.50
|
|
|
ROBITUSSIN-DM/10ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633834
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ROBITUSSIN-DM/10ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633834
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
ROBITUSSIN-DM/120ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633833
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ROBITUSSIN-DM/120ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633833
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
ROBITUSSIN DM/16OZ
|
Facility
|
IP
|
$72.00
|
|
| Hospital Charge Code |
60634594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
|
|
ROBITUSSIN DM/16OZ
|
Facility
|
OP
|
$72.00
|
|
| Hospital Charge Code |
60634594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Medicare Advantage |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$18.36
|
| Rate for Payer: Cigna Commercial |
$36.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$9.36
|
| Rate for Payer: Oxford Commercial |
$36.00
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$10.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.00
|
|
|
ROBITUSSIN-DM/5ML
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
60633835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Medicare Advantage |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$0.77
|
| Rate for Payer: Cigna Commercial |
$1.50
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$0.39
|
| Rate for Payer: Oxford Commercial |
$1.50
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
| Rate for Payer: UnitedHealthcare Commercial |
$1.50
|
|
|
ROBITUSSIN-DM/5ML
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
60633835
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$0.45
|
|
|
ROBITUSSIN PE/16OZ
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
60634595
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$9.90
|
|