|
ROPIVACAINE 0.1% + FENTANYL 1 MCG/ML EPI
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41645457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
|
|
ROPIVACAINE 0.2$ NS 250ML-1MG
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41650499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
|
|
ROPIVACAINE 0.2$ NS 250ML-1MG
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41650499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.00
|
| Rate for Payer: Group Health Inc Commercial |
$20.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.00
|
|
|
ROPIVACAINE 0.2% 200MG/100ML IVPB
|
Facility
|
OP
|
$9.30
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41647819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$5.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.35
|
| Rate for Payer: Group Health Inc Commercial |
$4.65
|
| Rate for Payer: Group Health Inc Medicare |
$3.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.04
|
|
|
ROPIVACAINE 0.2% 200MG/100ML IVPB
|
Facility
|
OP
|
$9.30
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41657819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$6.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$5.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.35
|
| Rate for Payer: Group Health Inc Commercial |
$4.65
|
| Rate for Payer: Group Health Inc Medicare |
$3.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.04
|
|
|
ROPIVACAINE 0.2% 200MG/100ML IVPB
|
Facility
|
IP
|
$9.30
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41647819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.65
|
|
|
ROPIVACAINE 0.2% 200MG/100ML IVPB
|
Facility
|
IP
|
$9.30
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41657819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$4.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.65
|
|
|
ROPIVACAINE 0.2% EPIDURAL INFUSION 200 M
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
41644742
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.00
|
| Rate for Payer: Aetna Government |
$35.00
|
| Rate for Payer: Brighton Health Commercial |
$52.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.60
|
| Rate for Payer: Group Health Inc Commercial |
$35.00
|
| Rate for Payer: Group Health Inc Medicare |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.50
|
|
|
ROPIVACAINE 0.2% EPIDURAL INFUSION 200 M
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
41654742
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.00
|
| Rate for Payer: Aetna Government |
$35.00
|
| Rate for Payer: Brighton Health Commercial |
$52.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.60
|
| Rate for Payer: Group Health Inc Commercial |
$35.00
|
| Rate for Payer: Group Health Inc Medicare |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.50
|
|
|
ROPIVACAINE 0.2% NS 250ML-1MG
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41640499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
|
|
ROPIVACAINE 0.2% NS 250ML-1MG
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41640499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.00
|
| Rate for Payer: Group Health Inc Commercial |
$20.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.00
|
|
|
ROPIVACAINE 0.5 % INJ
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41652459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
ROPIVACAINE 0.5 % INJ
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41642459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
ROPIVACAINE 0.5 % INJ
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41652459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
|
|
ROPIVACAINE 0.5 % INJ
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41642459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
ROPIVACAINE 1% INJ 10 ML
|
Facility
|
OP
|
$0.17
|
|
| Hospital Charge Code |
41645251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
ROPIVACAINE 1% INJ 10 ML
|
Facility
|
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41655251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
ROPIVACAINE 1% INJ 10 ML
|
Facility
|
IP
|
$0.17
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41655251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
ROPIVACAINE 1% INJ 10 ML
|
Facility
|
IP
|
$0.17
|
|
| Hospital Charge Code |
41645251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
ROPIVACAINE 1% INJ 20 ML
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41642460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
ROPIVACAINE 1% INJ 20 ML
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41652460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
|
|
ROPIVACAINE 1% INJ 20 ML
|
Facility
|
IP
|
$0.15
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41642460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
|
|
ROPIVACAINE 1% INJ 20 ML
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41652460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.10
|
|
|
ROPIVACAINE 400MG/200ML PREMIX
|
Facility
|
IP
|
$0.05
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41657940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
|
|
ROPIVACAINE 400MG/200ML PREMIX
|
Facility
|
OP
|
$0.05
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
41657940
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.07
|
| Rate for Payer: SOMOS Essential |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
