|
RIVAROXABAN 20 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045857901
|
| Hospital Charge Code |
5045857901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 20 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
5045857930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 20 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045857930
|
| Hospital Charge Code |
5045857930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVAROXABAN 20 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045857901
|
| Hospital Charge Code |
5045857901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVAROXABAN 20 MG PO TABS
|
Facility
|
OP
|
$22.78
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
5045857910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.97 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.49
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$7.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
RIVAROXABAN 20 MG PO TABS
|
Facility
|
IP
|
$22.78
|
|
|
Service Code
|
NDC 5045857910
|
| Hospital Charge Code |
5045857910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.39
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
NDC 5199189999
|
| Hospital Charge Code |
5199189999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 0781731331
|
| Hospital Charge Code |
0781731331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.45
|
| Rate for Payer: Aetna Government |
$8.45
|
| Rate for Payer: Brighton Health Commercial |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.49
|
| Rate for Payer: EmblemHealth Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Medicare |
$5.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.98
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
NDC 0781731358
|
| Hospital Charge Code |
0781731358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 5199189999
|
| Hospital Charge Code |
5199189999
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.45
|
| Rate for Payer: Aetna Government |
$8.45
|
| Rate for Payer: Brighton Health Commercial |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.49
|
| Rate for Payer: EmblemHealth Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Medicare |
$5.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.98
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24
|
Facility
|
OP
|
$16.90
|
|
|
Service Code
|
NDC 0781731358
|
| Hospital Charge Code |
0781731358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.45
|
| Rate for Payer: Aetna Government |
$8.45
|
| Rate for Payer: Brighton Health Commercial |
$12.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.49
|
| Rate for Payer: EmblemHealth Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Commercial |
$8.45
|
| Rate for Payer: Group Health Inc Medicare |
$5.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.98
|
|
|
RIVASTIGMINE 13.3 MG/24HR TD PT24
|
Facility
|
IP
|
$16.90
|
|
|
Service Code
|
NDC 0781731331
|
| Hospital Charge Code |
0781731331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.45
|
|
|
ROCURONIUM BROMIDE 100 MG/10ML IV SOLN
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 6332342610
|
| Hospital Charge Code |
6332342610
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
|
|
ROCURONIUM BROMIDE 100 MG/10ML IV SOLN
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 6332342610
|
| Hospital Charge Code |
6332342610
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Brighton Health Commercial |
$1.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: EmblemHealth Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.06
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 4354753010
|
| Hospital Charge Code |
4354753010
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$0.89
|
|
|
Service Code
|
NDC 4354753001
|
| Hospital Charge Code |
4354753001
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 7261175601
|
| Hospital Charge Code |
7261175601
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.71
|
| Rate for Payer: Aetna Government |
$0.71
|
| Rate for Payer: Brighton Health Commercial |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.96
|
| Rate for Payer: EmblemHealth Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Medicare |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.92
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 6332342602
|
| Hospital Charge Code |
6332342602
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 8156520402
|
| Hospital Charge Code |
8156520402
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.38
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
NDC 8156520402
|
| Hospital Charge Code |
8156520402
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$1.21
|
|
|
Service Code
|
NDC 6745722805
|
| Hospital Charge Code |
6745722805
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$0.96
|
|
|
Service Code
|
NDC 7128870005
|
| Hospital Charge Code |
7128870005
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 6332342605
|
| Hospital Charge Code |
6332342605
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 5515022505
|
| Hospital Charge Code |
5515022505
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 7261175610
|
| Hospital Charge Code |
7261175610
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.71
|
| Rate for Payer: Aetna Government |
$0.71
|
| Rate for Payer: Brighton Health Commercial |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.96
|
| Rate for Payer: EmblemHealth Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Medicare |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.92
|
|
