St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MEPERIDINE 50 MG/ML INJ VIAL

Facility

$2.00

Service Code	HCPCS J2175
Hospital Charge Code	41652398
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

MEPERIDINE 50 MG/ML INJ VIAL

Facility

$2.00

Service Code	HCPCS J2175
Hospital Charge Code	41642398
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

MEPERIDINE 50 MG/ML INJ VIAL

Facility

$2.00

Service Code	HCPCS J2175
Hospital Charge Code	41652398
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

MEPERIDINE 50 MG/ML INJ VIAL

Facility

$2.00

Service Code	HCPCS J2175
Hospital Charge Code	41642398
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

MEPERIDINE 50 MG TAB

Facility

$1.00

Hospital Charge Code	41654601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MEPERIDINE 50 MG TAB

Facility

$1.00

Hospital Charge Code	41644601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

MEPERIDINE 75 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41642400
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

MEPERIDINE 75 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41642400
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

MEPERIDINE 75 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41652400
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

MEPERIDINE 75 MG/ML INJ

Facility

$3.00

Service Code	HCPCS J2175
Hospital Charge Code	41652400
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

MEPERIDINE 75MGML INJ

Facility

$0.46

Service Code	HCPCS J2175
Hospital Charge Code	41648137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

MEPERIDINE 75MGML INJ

Facility

$0.46

Service Code	HCPCS J2175
Hospital Charge Code	41658137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

MEPERIDINE 75MGML INJ

Facility

$0.46

Service Code	HCPCS J2175
Hospital Charge Code	41658137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23

MEPERIDINE 75MGML INJ

Facility

$0.46

Service Code	HCPCS J2175
Hospital Charge Code	41648137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.31
Rate for Payer: SOMOS Essential	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

MEPERIDINE HCL 100 MG/ML IJ SOLN [4902]

Facility

$7.68

Service Code	HCPCS J2175
Hospital Charge Code	00409118069
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$5.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.22
Rate for Payer: Group Health Inc Commercial	$3.84
Rate for Payer: Group Health Inc Medicare	$2.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.84
Rate for Payer: Hamaspik Choice Inc Medicare	$3.84
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.99

MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]

Facility

$7.25

Service Code	HCPCS J2175
Hospital Charge Code	00409117630
Hospital Revenue Code	250
Min. Negotiated Rate	$2.54
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$5.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.93
Rate for Payer: Group Health Inc Commercial	$3.62
Rate for Payer: Group Health Inc Medicare	$2.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.62
Rate for Payer: Hamaspik Choice Inc Medicare	$3.62
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.71

MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]

Facility

$3.04

Service Code	HCPCS J2175
Hospital Charge Code	00641605225
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

MEPERIDINE HCL 25 MG/ML IJ SOLN [4903]

Facility

$3.05

Service Code	HCPCS J2175
Hospital Charge Code	00641605201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

MEPERIDINE HCL 50 MG/ML IJ SOLN [4904]

Facility

$9.07

Service Code	HCPCS J2175
Hospital Charge Code	00409117830
Hospital Revenue Code	250
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$6.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.16
Rate for Payer: Group Health Inc Commercial	$4.53
Rate for Payer: Group Health Inc Medicare	$3.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.53
Rate for Payer: Hamaspik Choice Inc Medicare	$4.53
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.89

MEPERIDINE HCL 75 MG/ML IJ SOLN [4905]

Facility

$7.68

Service Code	HCPCS J2175
Hospital Charge Code	00409117930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$7.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.48
Rate for Payer: Aetna Government	$6.48
Rate for Payer: Brighton Health Commercial	$5.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.22
Rate for Payer: Group Health Inc Commercial	$3.84
Rate for Payer: Group Health Inc Medicare	$2.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.84
Rate for Payer: Hamaspik Choice Inc Medicare	$3.84
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$6.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$7.31
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$7.31
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.99

MEPIVACAINE 1.5% 30ML INJ -10ML

Facility

$2.76

Service Code	HCPCS J0670
Hospital Charge Code	41648442
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.76
Rate for Payer: Aetna Government	$2.76
Rate for Payer: Brighton Health Commercial	$1.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.59
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.77
Rate for Payer: SOMOS Essential	$3.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

MEPIVACAINE 1.5% 30ML INJ -10ML

Facility

$2.76

Service Code	HCPCS J0670
Hospital Charge Code	41648442
Hospital Revenue Code	636
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38

MEPIVACAINE 1.5% 30ML INJ-10ML

Facility

$2.76

Service Code	HCPCS J0670
Hospital Charge Code	41658442
Hospital Revenue Code	636
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38

MEPIVACAINE 1.5% 30ML INJ-10ML

Facility

$2.76

Service Code	HCPCS J0670
Hospital Charge Code	41658442
Hospital Revenue Code	636
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.76
Rate for Payer: Aetna Government	$2.76
Rate for Payer: Brighton Health Commercial	$1.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.59
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.77
Rate for Payer: SOMOS Essential	$3.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

MEPIVACAINE HCL (PF) 1.5 % IJ SOLN [180666]

Facility

$0.53

Service Code	HCPCS J0670
Hospital Charge Code	63323029337
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.76
Rate for Payer: Aetna Government	$2.76
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$3.56
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$3.77
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$3.77
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$3.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

Know your out-of-pocket cost for care.

All Charges