St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MISOPROSTOL 200 MCG PO TABS [10629]

Facility

$1.20

Service Code	NDC 59762500801
Hospital Charge Code	59762500801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

MISOPROSTOL 200 MCG PO TABS [10629]

Facility

$1.43

Service Code	NDC 70954044420
Hospital Charge Code	70954044420
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

MISOPROSTOL 200 MCG PO TABS [10629]

Facility

$1.43

Service Code	NDC 43386016101
Hospital Charge Code	43386016101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

MISOPROSTOL 200 MCG PO TABS [10629]

Facility

$2.73

Service Code	NDC 60687074601
Hospital Charge Code	60687074601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.77

MISOPROSTOL 200 MCG PO TABS [10629]

Facility

$1.43

Service Code	NDC 43386016106
Hospital Charge Code	43386016106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.93

MISOPROSTOL 200 MCG PO TABS [10629]

Facility

$2.73

Service Code	NDC 60687074611
Hospital Charge Code	60687074611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.36
Rate for Payer: Aetna Government	$1.36
Rate for Payer: Brighton Health Commercial	$2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: Group Health Inc Commercial	$1.36
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.36
Rate for Payer: Hamaspik Choice Inc Medicare	$1.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.77

MISOPROSTOL 200 MCG TAB

Facility

$4.72

Hospital Charge Code	41641242
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.21
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.07

MISOPROSTOL 200 MCG TAB

Facility

$4.72

Hospital Charge Code	41651242
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.21
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.07

MISOPROSTOL 25 MCG TAB

Facility

$71.00

Hospital Charge Code	41654720
Hospital Revenue Code	250
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$56.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.50
Rate for Payer: Aetna Government	$35.50
Rate for Payer: Brighton Health Commercial	$53.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.28
Rate for Payer: Group Health Inc Commercial	$35.50
Rate for Payer: Group Health Inc Medicare	$24.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.50
Rate for Payer: Hamaspik Choice Inc Medicare	$35.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.15

MISOPROSTOL 25 MCG TAB

Facility

$71.00

Hospital Charge Code	41644720
Hospital Revenue Code	250
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$56.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.50
Rate for Payer: Aetna Government	$35.50
Rate for Payer: Brighton Health Commercial	$53.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$56.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.28
Rate for Payer: Group Health Inc Commercial	$35.50
Rate for Payer: Group Health Inc Medicare	$24.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.50
Rate for Payer: Hamaspik Choice Inc Medicare	$35.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.15

MITEK SCREWDRIVER MENISCAL 2MM CL

Facility

$224.00

Hospital Charge Code	40203348
Hospital Revenue Code	272
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$179.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.00
Rate for Payer: Aetna Government	$112.00
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$152.32
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

MITEK SCREWDRIVER MENISCAL 2MM CL

Facility

$224.00

Hospital Charge Code	40009331
Hospital Revenue Code	272
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$179.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$123.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$112.00
Rate for Payer: Aetna Government	$112.00
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$179.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$152.32
Rate for Payer: Group Health Inc Commercial	$112.00
Rate for Payer: Group Health Inc Medicare	$78.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$112.00
Rate for Payer: Hamaspik Choice Inc Medicare	$112.00

MITOCHONDRIAL (M2) ANTIBODY

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40729239
Hospital Revenue Code	300
Min. Negotiated Rate	$8.07
Max. Negotiated Rate	$21.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.53
Rate for Payer: Aetna Government	$11.53
Rate for Payer: Affinity Essential Plan 1&2	$8.07
Rate for Payer: Affinity Essential Plan 3&4	$8.07
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.07
Rate for Payer: Brighton Health Commercial	$21.62
Rate for Payer: Cash Price	$11.53
Rate for Payer: Cash Price	$11.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.52
Rate for Payer: Elderplan Medicare Advantage	$11.53
Rate for Payer: EmblemHealth Commercial	$11.53
Rate for Payer: Fidelis Essential Plan Aliesa	$9.80
Rate for Payer: Fidelis Essential Plan QHP	$10.26
Rate for Payer: Fidelis Medicare Advantage	$11.53
Rate for Payer: Fidelis Qualified Health Plan	$10.26
Rate for Payer: Group Health Inc Commercial	$11.53
Rate for Payer: Group Health Inc Medicare	$11.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.42
Rate for Payer: Hamaspik Choice Inc Medicare	$11.53
Rate for Payer: Healthfirst Medicare Advantage	$11.53
Rate for Payer: Healthfirst QHP	$11.53
Rate for Payer: Humana Medicare	$11.76
Rate for Payer: Senior Whole Health Medicare Advantage	$11.53
Rate for Payer: United Healthcare Commercial	$14.62
Rate for Payer: United Healthcare Medicare Advantage	$11.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.53
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.22
Rate for Payer: Wellcare Medicare	$10.38

MITOCHONDRIAL (M2) ANTIBODY

Facility

$28.83

Service Code	HCPCS 83516
Hospital Charge Code	40729239
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.53

MITOMYCIN 20 MG IV SOLR [10630]

Facility

$540.00

Service Code	HCPCS J9280
Hospital Charge Code	71288013850
Hospital Revenue Code	278
Min. Negotiated Rate	$50.68
Max. Negotiated Rate	$351.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$297.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$324.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$63.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$270.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$310.50
Rate for Payer: Elderplan Medicare Advantage	$63.35
Rate for Payer: EmblemHealth Commercial	$270.00
Rate for Payer: Fidelis Medicare Advantage	$63.35
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$270.00
Rate for Payer: Healthfirst Medicare Advantage	$53.85
Rate for Payer: Healthfirst QHP	$63.35
Rate for Payer: Humana Medicare	$64.61
Rate for Payer: Senior Whole Health Medicare Advantage	$63.35
Rate for Payer: United Healthcare Medicare Advantage	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$351.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.68

MITOMYCIN 20 MG IV SOLR [10630]

Facility

$540.00

Service Code	HCPCS J9280
Hospital Charge Code	71288013850
Hospital Revenue Code	278
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$270.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$270.00
Rate for Payer: Hamaspik Choice Inc Medicare	$270.00

MITOMYCIN 20 MG IV SOLR [10630]

Facility

$758.40

Service Code	HCPCS J9280
Hospital Charge Code	00143927901
Hospital Revenue Code	278
Min. Negotiated Rate	$379.20
Max. Negotiated Rate	$379.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$379.20
Rate for Payer: Hamaspik Choice Inc Medicare	$379.20

MITOMYCIN 20 MG IV SOLR [10630]

Facility

$758.40

Service Code	HCPCS J9280
Hospital Charge Code	00143927901
Hospital Revenue Code	278
Min. Negotiated Rate	$50.68
Max. Negotiated Rate	$492.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$417.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$455.04
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$63.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$379.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$436.08
Rate for Payer: Elderplan Medicare Advantage	$63.35
Rate for Payer: EmblemHealth Commercial	$379.20
Rate for Payer: Fidelis Medicare Advantage	$63.35
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$379.20
Rate for Payer: Hamaspik Choice Inc Medicare	$379.20
Rate for Payer: Healthfirst Medicare Advantage	$53.85
Rate for Payer: Healthfirst QHP	$63.35
Rate for Payer: Humana Medicare	$64.61
Rate for Payer: Senior Whole Health Medicare Advantage	$63.35
Rate for Payer: United Healthcare Medicare Advantage	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$492.96
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.68

MITOMYCIN 40 MG IV SOLR [10631]

Facility

$1,415.64

Service Code	HCPCS J9280
Hospital Charge Code	67457052040
Hospital Revenue Code	278
Min. Negotiated Rate	$707.82
Max. Negotiated Rate	$707.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$707.82
Rate for Payer: Hamaspik Choice Inc Medicare	$707.82

MITOMYCIN 40 MG IV SOLR [10631]

Facility

$1,415.64

Service Code	HCPCS J9280
Hospital Charge Code	16729011638
Hospital Revenue Code	278
Min. Negotiated Rate	$707.82
Max. Negotiated Rate	$707.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$707.82
Rate for Payer: Hamaspik Choice Inc Medicare	$707.82

MITOMYCIN 40 MG IV SOLR [10631]

Facility

$1,415.64

Service Code	HCPCS J9280
Hospital Charge Code	16729011638
Hospital Revenue Code	278
Min. Negotiated Rate	$50.68
Max. Negotiated Rate	$920.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$778.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$849.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$63.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$707.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$813.99
Rate for Payer: Elderplan Medicare Advantage	$63.35
Rate for Payer: EmblemHealth Commercial	$707.82
Rate for Payer: Fidelis Medicare Advantage	$63.35
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$707.82
Rate for Payer: Hamaspik Choice Inc Medicare	$707.82
Rate for Payer: Healthfirst Medicare Advantage	$53.85
Rate for Payer: Healthfirst QHP	$63.35
Rate for Payer: Humana Medicare	$64.61
Rate for Payer: Senior Whole Health Medicare Advantage	$63.35
Rate for Payer: United Healthcare Medicare Advantage	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$920.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.68

MITOMYCIN 40 MG IV SOLR [10631]

Facility

$1,415.64

Service Code	HCPCS J9280
Hospital Charge Code	67457052040
Hospital Revenue Code	278
Min. Negotiated Rate	$50.68
Max. Negotiated Rate	$920.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$778.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Brighton Health Commercial	$849.38
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$63.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$707.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$813.99
Rate for Payer: Elderplan Medicare Advantage	$63.35
Rate for Payer: EmblemHealth Commercial	$707.82
Rate for Payer: Fidelis Medicare Advantage	$63.35
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$707.82
Rate for Payer: Hamaspik Choice Inc Medicare	$707.82
Rate for Payer: Healthfirst Medicare Advantage	$53.85
Rate for Payer: Healthfirst QHP	$63.35
Rate for Payer: Humana Medicare	$64.61
Rate for Payer: Senior Whole Health Medicare Advantage	$63.35
Rate for Payer: United Healthcare Medicare Advantage	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$920.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.68

MITOMYCIN 5 MG INJ

Facility

$39.06

Service Code	HCPCS J9280
Hospital Charge Code	41640580
Hospital Revenue Code	636
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$19.53
Rate for Payer: Cash Price	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.53
Rate for Payer: Hamaspik Choice Inc Medicare	$19.53

MITOMYCIN 5 MG INJ

Facility

$39.06

Service Code	HCPCS J9280
Hospital Charge Code	41640580
Hospital Revenue Code	636
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$71.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.35
Rate for Payer: Aetna Government	$63.35
Rate for Payer: Affinity Essential Plan 1&2	$44.34
Rate for Payer: Affinity Essential Plan 3&4	$44.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$44.34
Rate for Payer: Brighton Health Commercial	$23.44
Rate for Payer: Cash Price	$63.35
Rate for Payer: Cash Price	$63.35
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$63.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.46
Rate for Payer: Elderplan Medicare Advantage	$63.35
Rate for Payer: EmblemHealth Commercial	$63.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$63.35
Rate for Payer: Fidelis Essential Plan Aliesa	$63.35
Rate for Payer: Fidelis Essential Plan QHP	$66.52
Rate for Payer: Fidelis Medicare Advantage	$63.35
Rate for Payer: Fidelis Qualified Health Plan	$66.52
Rate for Payer: Group Health Inc Commercial	$63.35
Rate for Payer: Group Health Inc Medicare	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.53
Rate for Payer: Hamaspik Choice Inc Medicare	$19.53
Rate for Payer: Healthfirst Medicare Advantage	$53.85
Rate for Payer: Healthfirst QHP	$63.35
Rate for Payer: Humana Medicare	$64.61
Rate for Payer: Senior Whole Health Medicare Advantage	$63.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.05
Rate for Payer: SOMOS Essential	$71.05
Rate for Payer: United Healthcare Commercial	$44.47
Rate for Payer: United Healthcare Medicare Advantage	$63.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.68
Rate for Payer: Wellcare Medicare	$60.18

MITOMYCIN 5 MG INJ

Facility

$39.06

Service Code	HCPCS J9280
Hospital Charge Code	41650580
Hospital Revenue Code	636
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$19.53
Rate for Payer: Cash Price	$63.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.53
Rate for Payer: Hamaspik Choice Inc Medicare	$19.53

Know your out-of-pocket cost for care.

All Charges