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All Charges

Charge

Type

Setting

Price

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

OP

$0.59

Service Code	NDC 81565020402
Hospital Charge Code	81565020402
Hospital Revenue Code	278
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.62
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	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Fidelis Medicare Advantage	$0.62
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 [95811]

Facility

IP

$0.89

Service Code	NDC 43547053001
Hospital Charge Code	43547053001
Hospital Revenue Code	278
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

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

IP

$1.41

Service Code	NDC 72611075610
Hospital Charge Code	72611075610
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

ROCURONIUM BROMIDE 50 MG/5ML IV SOLN [95811]

Facility

OP

$0.89

Service Code	NDC 43547053010
Hospital Charge Code	43547053010
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

$1.63

Service Code	NDC 63323042605
Hospital Charge Code	63323042605
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

$0.89

Service Code	NDC 43547053001
Hospital Charge Code	43547053001
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

OP

$2.10

Service Code	NDC 55150022505
Hospital Charge Code	55150022505
Hospital Revenue Code	278
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$2.21
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	$2.21
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

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

$0.89

Service Code	NDC 00409955805
Hospital Charge Code	00409955805
Hospital Revenue Code	278
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

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

OP

$1.21

Service Code	NDC 67457022805
Hospital Charge Code	67457022805
Hospital Revenue Code	278
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$1.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.61
Rate for Payer: Aetna Government	$0.61
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: EmblemHealth Commercial	$0.61
Rate for Payer: Fidelis Medicare Advantage	$1.27
Rate for Payer: Group Health Inc Commercial	$0.61
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.61
Rate for Payer: Hamaspik Choice Inc Medicare	$0.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.79

ROC XS ANCHOR 3.5M/10CM

Facility

OP

$6.48

Hospital Charge Code	64902788
Hospital Revenue Code	270
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.24
Rate for Payer: Aetna Government	$3.24
Rate for Payer: Brighton Health Commercial	$4.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.41
Rate for Payer: Group Health Inc Commercial	$3.24
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24

ROD 100MM STRIGHT ES2

Facility

OP

$3,235.33

Service Code	HCPCS C1713
Hospital Charge Code	64904729
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,397.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,779.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,941.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,617.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,860.31
Rate for Payer: EmblemHealth Commercial	$1,617.66
Rate for Payer: Fidelis Medicare Advantage	$3,397.10
Rate for Payer: Group Health Inc Commercial	$1,617.66
Rate for Payer: Group Health Inc Medicare	$1,132.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.66
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,102.96

ROD 100MM STRIGHT ES2

Facility

IP

$3,235.33

Service Code	HCPCS C1713
Hospital Charge Code	64904729
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.66
Max. Negotiated Rate	$1,617.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.66
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.66

ROD 120MM 4.0 -540120

Facility

IP

$1,666.00

Service Code	HCPCS C1713
Hospital Charge Code	64906740
Hospital Revenue Code	278
Min. Negotiated Rate	$833.00
Max. Negotiated Rate	$833.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.00
Rate for Payer: Hamaspik Choice Inc Medicare	$833.00

ROD 120MM 4.0 -540120

Facility

OP

$1,666.00

Service Code	HCPCS C1713
Hospital Charge Code	64906740
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,749.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$916.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$999.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$833.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$957.95
Rate for Payer: EmblemHealth Commercial	$833.00
Rate for Payer: Fidelis Medicare Advantage	$1,749.30
Rate for Payer: Group Health Inc Commercial	$833.00
Rate for Payer: Group Health Inc Medicare	$583.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.00
Rate for Payer: Hamaspik Choice Inc Medicare	$833.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,082.90

ROD 240MM

Facility

OP

$1,666.00

Service Code	HCPCS C1713
Hospital Charge Code	64906883
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,749.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$916.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$999.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$833.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$957.95
Rate for Payer: EmblemHealth Commercial	$833.00
Rate for Payer: Fidelis Medicare Advantage	$1,749.30
Rate for Payer: Group Health Inc Commercial	$833.00
Rate for Payer: Group Health Inc Medicare	$583.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.00
Rate for Payer: Hamaspik Choice Inc Medicare	$833.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,082.90

ROD 240MM

Facility

IP

$1,666.00

Service Code	HCPCS C1713
Hospital Charge Code	64906883
Hospital Revenue Code	278
Min. Negotiated Rate	$833.00
Max. Negotiated Rate	$833.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.00
Rate for Payer: Hamaspik Choice Inc Medicare	$833.00

ROD 30CM 5.0SS MOSS MIAMI

Facility

OP

$760.00

Service Code	HCPCS C1713
Hospital Charge Code	40200742
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$798.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$418.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$456.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$437.00
Rate for Payer: EmblemHealth Commercial	$380.00
Rate for Payer: Fidelis Medicare Advantage	$798.00
Rate for Payer: Group Health Inc Commercial	$380.00
Rate for Payer: Group Health Inc Medicare	$266.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$380.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$494.00

ROD 30CM 5.0SS MOSS MIAMI

Facility

IP

$760.00

Service Code	HCPCS C1713
Hospital Charge Code	40200742
Hospital Revenue Code	278
Min. Negotiated Rate	$380.00
Max. Negotiated Rate	$380.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$380.00

ROD 30MM

Facility

OP

$657.90

Service Code	HCPCS C1713
Hospital Charge Code	64903929
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$690.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$394.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.29
Rate for Payer: EmblemHealth Commercial	$328.95
Rate for Payer: Fidelis Medicare Advantage	$690.79
Rate for Payer: Group Health Inc Commercial	$328.95
Rate for Payer: Group Health Inc Medicare	$230.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.95
Rate for Payer: Hamaspik Choice Inc Medicare	$328.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.63

ROD 30MM

Facility

IP

$657.90

Service Code	HCPCS C1713
Hospital Charge Code	64903929
Hospital Revenue Code	278
Min. Negotiated Rate	$328.95
Max. Negotiated Rate	$328.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.95
Rate for Payer: Hamaspik Choice Inc Medicare	$328.95