|
ROCKY MTN SPOTTED FEV, IGG, QN
|
Facility
|
IP
|
$48.38
|
|
|
Service Code
|
HCPCS 86757
|
| Hospital Charge Code |
40729835
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$19.35
|
|
|
ROCURONIUM 10 MG/ML INJ
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
ROCURONIUM 10 MG/ML INJ
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
ROCURONIUM 10 MG/ML INJ
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
ROCURONIUM 10 MG/ML INJ
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650534
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$4.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
ROCURONIUM 200MG/100ML
|
Facility
|
IP
|
$33.29
|
|
| Hospital Charge Code |
41640225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
|
|
ROCURONIUM 200MG/100ML
|
Facility
|
IP
|
$33.29
|
|
| Hospital Charge Code |
41650225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
|
|
ROCURONIUM 200MG/100ML
|
Facility
|
OP
|
$33.29
|
|
| Hospital Charge Code |
41650225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.64
|
| Rate for Payer: Aetna Government |
$16.64
|
| Rate for Payer: Brighton Health Commercial |
$19.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.14
|
| Rate for Payer: Group Health Inc Commercial |
$16.64
|
| Rate for Payer: Group Health Inc Medicare |
$11.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.64
|
|
|
ROCURONIUM 200MG/100ML
|
Facility
|
OP
|
$33.29
|
|
| Hospital Charge Code |
41640225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.64
|
| Rate for Payer: Aetna Government |
$16.64
|
| Rate for Payer: Brighton Health Commercial |
$19.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.14
|
| Rate for Payer: Group Health Inc Commercial |
$16.64
|
| Rate for Payer: Group Health Inc Medicare |
$11.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.64
|
|
|
ROCURONIUM 500MG/NS 100ML
|
Facility
|
IP
|
$110.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.20
|
|
|
ROCURONIUM 500MG/NS 100ML
|
Facility
|
IP
|
$110.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.20
|
|
|
ROCURONIUM 500MG/NS 100ML
|
Facility
|
OP
|
$110.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.20
|
| Rate for Payer: Aetna Government |
$55.20
|
| Rate for Payer: Brighton Health Commercial |
$66.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.48
|
| Rate for Payer: Group Health Inc Commercial |
$55.20
|
| Rate for Payer: Group Health Inc Medicare |
$38.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.76
|
|
|
ROCURONIUM 500MG/NS 100ML
|
Facility
|
OP
|
$110.40
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640346
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.20
|
| Rate for Payer: Aetna Government |
$55.20
|
| Rate for Payer: Brighton Health Commercial |
$66.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.48
|
| Rate for Payer: Group Health Inc Commercial |
$55.20
|
| Rate for Payer: Group Health Inc Medicare |
$38.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.76
|
|
|
ROCURONIUM BROMIDE 100 MG/10ML IV SOLN [95812]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 63323042610
|
| Hospital Charge Code |
63323042610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.71 |
| 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 |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.93
|
| Rate for Payer: EmblemHealth Commercial |
$0.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.71
|
| 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 100 MG/10ML IV SOLN [95812]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 63323042610
|
| Hospital Charge Code |
63323042610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
NDC 66794022841
|
| Hospital Charge Code |
66794022841
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 63323042605
|
| Hospital Charge Code |
63323042605
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.71 |
| 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 |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.93
|
| Rate for Payer: EmblemHealth Commercial |
$0.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.71
|
| 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 [95811]
|
Facility
|
IP
|
$1.21
|
|
|
Service Code
|
NDC 67457022805
|
| Hospital Charge Code |
67457022805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.61
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
NDC 63323042602
|
| Hospital Charge Code |
63323042602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.71 |
| 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 |
$0.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.93
|
| Rate for Payer: EmblemHealth Commercial |
$0.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.71
|
| 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 [95811]
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 55150022505
|
| Hospital Charge Code |
55150022505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 00409955805
|
| Hospital Charge Code |
00409955805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.94 |
| 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 |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.51
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.94
|
| 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 [95811]
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 00143925010
|
| Hospital Charge Code |
00143925010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
NDC 63323042602
|
| Hospital Charge Code |
63323042602
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 55150022505
|
| Hospital Charge Code |
55150022505
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$1.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: EmblemHealth Commercial |
$1.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.20
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
NDC 72611075601
|
| Hospital Charge Code |
72611075601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.71
|
|
